Care Home: Moor Court

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What the care home does well People have up to date care plans and their changing needs are met. People go to daytime activities of their choice. They have a choice over their food and enjoy their mealtimes. People are helped to make decisions and giving their views. They are supported to have friends and stay in touch with their families. People are well supported with their health needs. People live in a safe, warm and well kept home with a large garden with nice views. People all have their own bedrooms with lots of personal things in them. People like the staff team that help them. The service is well managed for the benefit of people living in the home. What has improved since the last inspection? People are being helped by their keyworkers to make plans. People are being helped to try new activities and build more of a social life. People are being helped to be more independent and learn new skills. The staff team is much larger, and better supported and trained. Record keeping has got better to help protect people. What the care home could do better: People should have a care review twice a year. One medicine should be stored more safely. Cleaning chemicals should be stored safely. Make sure the house smells nice in all areas. The plans to improve the service should all be actioned. They include; People being given more information in a way they understand. The house layout being changed to better meet people`s needs and to give everyone an ensuite bathroom.For more of the staff to gain qualifications in Care. To develop better ways to check on the quality of the service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Moor Court Bodenham Herefordshire HR1 3HW     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: Jean Littler     Date: 1 5 0 1 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 33 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Moor Court Bodenham Herefordshire HR1 3HW 01568797461 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): moor-court@btconnect.com The Silver Rooms (Stroud) Ltd Name of registered manager (if applicable) Rosemary Elizabeth Gladys Valerie Wooderson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 13. The registered person may provide the following category of service only: Care home only to service users of either gender Whose primary care needs on admission to the home are within the following category: Learning Disability (LD) 13 Date of last inspection Brief description of the care home Mr Kidd is the sole director of the company that operates Moor Court and one other Care Home. Moor Court is based in the rural community of Bodenham. The service provides personal care for up to thirteen adults with learning disabilities in a large three storey detached house. Information about the Home is available from the Home or provider on request. 13 Over 65 0 care home 13 Care Homes for Adults (18-65 years) Page 4 of 33 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: We, the Commission, carried out this inspection over seven hours. The last inspection was on 17th January 2008. The manager, Ms Wooderson, and owner, Mr Kidd, both helped with the process. We looked around the house and spoke with some people who live there. We looked at some records such as care plans, medication and money. Eight people living in the home, two families, five staff, and one doctor gave us their Care Homes for Adults (18-65 years) Page 5 of 33 views in surveys. The manager sent information about the service to us before the visit in the AQAA. The Annual Quality Assurance Assessment. The Service Users Guide says the weekly fees are 500 pounds plus some transport costs. People also have to pay for their own clothes and toiletries, haircuts, chiropody, activities and day care. A seven day holiday is included in the fees What the care home does well: What has improved since the last inspection? What they could do better: People should have a care review twice a year. One medicine should be stored more safely. Cleaning chemicals should be stored safely. Make sure the house smells nice in all areas. The plans to improve the service should all be actioned. They include; People being given more information in a way they understand. The house layout being changed to better meet peoples needs and to give everyone an ensuite bathroom. Care Homes for Adults (18-65 years) Page 7 of 33 For more of the staff to gain qualifications in Care. To develop better ways to check on the quality of the service. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 33 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 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures indicate that interested people will be given information about the service, have their needs assessed and be able to try out the service. Documents to support this process can be further developed to help ensure positive outcomes for people moving in and those already in residence. Evidence: The provider submitted a Statement of Purpose as part of the registration process in 2007. As reported at the last inspection this should be reviewed as it reports the service is designed for a wide variety of special needs i.e. people having mild to moderate needs with some challenging behaviours, people needing a high level of supervision, mental health needs, personality disorders or Autism. If the accommodation continues to be provided as a large communal Home then it would be inappropriate for people with such special needs to be admitted. A revised version has not yet been seen by us. There is a written Service Users Guide. Ms Wooderson had planned to develop a Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: version that is more accessible to people with a learning disability by August 2008. This plan has been rolled forward for 2009. People have formal contracts between the company and the funding authorities. Mr Kidd has recently issued Terms and Conditions to the people living in the Home. The document is very similar to the one in place with the previous owners and no pictures or symbols have been added to aid peoples understanding. Mrs Wooderson reported in the AQAA that the following plans are in place for 2009. To develop a user friendly guide to the home such as a DVD format. The Statement of Purpose should be adapted to make it easier to understand for service users who use written information but could find the document too lengthy or complex. Possibly develop the top floor of home to offer a more independent style of living, and possibly the grounds, for self contained flats. There are currently nine people in residence. Although the home is registered for thirteen Mr Kidd and Ms Wooderson understand that it is good practice for people to have their own bedrooms. There are only nine bedrooms so there are no plans to admit new people until the building has been redesigned to create more single bedrooms. The Statement of Purpose says that prospective people will have their needs fully assessed and then if a place is offered a personalised transition will be arranged that can include tea visits and overnight stays. A three month trial period will then be offered if appropriate. No short term or emergency placements will be accepted. Ms Wooderson had planned to develop an assessment tool by April 2008. She did not report in the AQAA that this had been achieved so it should be added to the action plan for 2009. Care Homes for Adults (18-65 years) Page 11 of 33 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 have their needs recorded in their care plans and these are being kept under close review. They are being encouraged to be involved in planning their support, make daily choices and decisions about their lives. Evidence: Each person has a care plan that contains information about their support needs, preferences, routines and risk assessments. These were in place when the home changed hands, however, Ms Wooderson has added information as peoples needs have changed. She has also changed some of the guidance so it is more respectful and positive about the individual. Appropriate records are being maintained such as a daily summary, monitoring charts, incident and accident reports. All records are being completed well and Ms Wooderson is using them to monitor peoples wellbeing, behaviours and changing needs. Keyworkers are completing monthly reports and review meetings have been held. People have been involved in these choosing who to invite and pictures have been put in the review reports to help people understand the Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: information. Now the staff team is becoming established keyworkers are going to support people to develop a person centred plan. They are already meeting their key residents twice a month to help them develop their wish lists. One person is very proud of her list and has posted it on her bedroom door. Some peoples wishes have been actioned, such as joining a gym, pub visits, a stream train trip and a day at formula one racing. Others are being planned for, such as two friends going on a short trip to Blackpool. Ms Wooderson anticipates that now the staffing is more settled arrangements will be made more promptly. People are being encouraged to take appropriate risks to improve their quality of life and these are recorded in the care plans. Ms Wooderson reported in the AQAA. We listen to the service users views on a regular basis both formally and informally. We value their opinions and respect their wishes. We act on their suggestions about new things they want to do. We have service user meetings and encourage assertiveness. We have a Keyworker system which gives people the opportunity to voice their needs privately. We hold review meetings and welcome input from families and day centre staff, if the service user wishes them to be present. Any staff member who is consulted by a service user over any important issue asks the person if this can be recorded and passed on to the manager. We host the North Herefordshire Self Advocacy Group. Our staff are not involved, but encourage service users to attend, and we listen to feedback from the facilitator. We send staff on training on Values and Attitudes, to raise awareness of key values and how to incorporate them into interaction with service users. Previously one staff member would have up to four key people, now they have no more than two so that they can focus properly on these people. People are now being enabled to make choices throughout the day as well as forward planning with their wish lists. A menu choice is given for the following day. A worker discussed with people what time suited them for their bath that evening. One man recently went out to choose a double bed and a new television for his room. Each person has time to go personal shopping for toiletries, clothes and hobby items. Some people are being encouraged to take new risks to become more independent, such as learning to go on the bus alone. People spoken with confirmed they are making decisions about their lives such as what to do as activities and when at home. Residents meetings and attending a selfadvocacy meeting also support people to make decisions and express their views. More information is being provided in an accessible way to promote understanding and Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: choice making, such as a pictorial staff rota, however there is scope to further develop this area. Care Homes for Adults (18-65 years) Page 14 of 33 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 are being enabled to develop personally, take on more responsibility and choose the activities they want to take part in. They keep in touch with family and friends and are developing a better social life. They have a choice at each meal and enjoy the food and mealtimes. Evidence: As stated above, people are being supported to make decisions about the activities and outings they take part in. All had enjoyed the pantomime they had attended in Hereford recently in small groups. Each person has an established weekly routine of attending day placements that they enjoy. On the weekdays they are at home people choose how to spend their time. For example, one woman has started having a lay in. Her doctor has said her morning medication should be taken no later than 9.30am so she is woken for this and then goes back to sleep. When at home people are choosing Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: and helping to make their own lunch and take part in activities of their choice, such as personal shopping or having a coffee in town. People continue to help around the house doing jobs such as washing and drying up. Some are now more involved in food preparation, the weekly shop and changing their beds. People are not yet doing their own washing although the majority could learn. A worker reported that the daily routines are a lot less regimented under the new management and there is a happier atmosphere. People were observed to be cheerfully interacting with each other and with the staff and owner. A small group went with Ms Wooderson to a yoga class and came back feeling positive, reporting improvements in balance and flexibility. One man was away visiting his family and another reported seeing her brothers family recently. The relatives were positive in their surveys. One said, A friendly and caring atmosphere is always apparent and over the last year more social activities have been introduced. Ms Wooderson reported in the AQAA, We have increased staffing during the day so that the people at home can have more individual or smaller group support for lifestyle choices. Increased the number of social outings enjoyed by service users. We have introduced more physical activity such as regular walks, yoga, and gym membership, for those wishing to take part. We have held a consultation exercise with people about what they would like to do regularly in their spare time, and have developed an activities planner. We have encouraged people to identify leisure activities they enjoy such as Karaoke or DVD nights, Wii games, birthday parties and seasonal celebrations. There are plans to, Develop peoples individual learning plans to maximise independent living sills. Create a staff role as Activities Coordinator and access training for this role. Develop the activities plan for the home as a whole and for individuals. People spoken with confirmed they had busy and enjoyable lives and had a choice over how they spend their time. Two people said they could not always choose what to do in the evenings. One particularly wanted to go to the pub more often. The new entertainment room is being used regularly for parties, pool and as a cinema. There is also a second television lounge upstairs. Photos displayed showed people having a good time with friends and family at the parties, the summer holiday and a recent day trip on a steam train. As one person enjoyed this so much it was arranged again for her birthday. There have been some months where staffing difficulties have limited the amount of outings and activities offered. This situation has now improved but Ms Wooderson is still the only person who can drive the minibus. One man has a mobility car and as with the previous owners he continues to give his permission for others to use the car. This allows small groups to go out as several of the staff can drive this car. It would be more appropriate if the service provides a car for general use and the man could then decide if he wants to keep his own vehicle or return to having the mobility benefit money instead. It is positive that there is a weekly activities budget to Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: help towards the costs people have to pay towards their activities. Ms Wooderson reported that the menu is made up of each persons favourite meals. A choice is offered and for the main meal they decide this the evening before. People spoken with said they liked the food. Records showed a varied diet with meals such as curry and roast dinners. A good choice of breakfasts are offered including crumpets, cheerios and porridge. Runner beans and potatoes were grown in the garden this year and there are plans to grow more things this summer. A pictorial menu is in use. People waiting for their evening meal did not know what was coming when they were asked. Ms Wooderson reported that to help people remember a picture menu will be set up in the dining area. Care Homes for Adults (18-65 years) Page 17 of 33 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 are being sensitively supported with their personal care in the way they prefer. Their health care needs are being prioritised and their medicines are being safely managed. Evidence: Ms Wooderson confirmed that people are going out to buy their own personal clothes, toiletries and towels. All looked well presented and those spoken with in private said they were happy with the way they are supported with their personal and health care. Everyone now has a single bedroom and people are encouraged to use the locks for privacy. People are given the opportunity to bath regularly at a time of their choice. A senior said it is positive that now there are five male staff they can provide the men with same gender care more often. One man reportedly gets particularly embarrassed if assisted by female staff. The staff spoken with were aware of the need to respect peoples right to privacy and dignity. Ms Wooderson reported in the AQAA, We respond effectively to complex healthcare needs. Observe privacy and dignity at all times. Follow up planned health checks for Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: teeth, eyes, blood levels etc. Encourage people to seek well man or woman checks. Provide training in specific health needs such as epilepsy and dementia. Provide staff with clear and updated guidelines in health files to meet service users health needs. Monitor new health issues and act to record and address these. Consult professionals for support when issues need medical input. Some people have complex health needs. These have been well managed with staff being trained and given clear written guidance about each condition. Monitoring charts are in place and doctors kept informed of changes. All staff spoken with were able to demonstrate a good understanding of the issues and emergency action they may need to take. One person has fallen twice recently and a referral has been made to the falls clinic. Plans are in place to provide this person and two others with ground floor ensuite bedrooms. These would reduce risks associated with getting upstairs and enable them to access their bedrooms independently. An occupational therapist was involved shortly after the change of ownership and her advice about the existing arrangements was implemented. A new stair lift has been fitted recently. Ms Wooderson advocated well for one person about a health incident and this eventually led to her receiving appropriate treatment. A consultant is now involved and an occupational therapist has carried out a risk assessment. Ms Wooderson agreed to review how decisions are recorded when the people lack the mental capacity to make the decision themselves. Good health is being promoted through increased physical exercise. Records seen showed that people have been attending all basic health appointments and well woman, well mans checks. Health Action Plans are in place but Ms Wooderson has plans to improve these. Staff have been provided with training about behaviours that can be challenging and guidance is in place about how staff should respond to these. Incidents are recorded and monitored. Psychology support was requested early in 2008 from the Community Team, but this has not yet been provided. A nurse has provided input for health needs such as epilepsy and diabetes. Support was also requested from the continence nurse but due to the delay staff have now developed their own strategies that are helping. A consultant reported in a survey that he feels the service is positive and there is good leadership. Both relatives who returned surveys said they were informed about health matters and that people were always having their needs met. The feedback from staff was also positive. One worker wrote, the service meets peoples needs very well and the manager gives good support and advice to staff. One of the residents died in December 2007. This was managed sensitively and the family and residents were fully involved. Ms Wooderson has continued to support people to express their feelings. A memorial was held in the summer in the garden Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: that many people came to. There is a named garden seat and balloons were released. A memory book has been made and photographs are displays to help with conversations. One person said this has all helped her a lot with the bereavement. The medication is being stored securely in a trolley. The records are being well maintained and showed doses had been given as prescribed. A 2008 reference guide is available for staff. The recently updated guidance for Care Homes from the Royal Pharmaceutical Society should also be accessed. The medication people are taking is being kept under review and changes have been made based on information and monitoring passed on to the doctor concerned. Ms Wooderson was not aware that one medication is a schedule 3 controlled drug CD. It is recommended that this is stored in an approved CD cabinet and records maintained in a CD register to reduce the risk of it being misused. Sensible arrangements are already in place for taking the medicine out on activities. Some staff have already attended an accredited training course and two are due to start this. Staff are not permitted to give medication until they have approved as competent by Ms Wooderson. Two errors have occurred in the last year where doses were not given. Care Homes for Adults (18-65 years) Page 20 of 33 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 are being encouraged to express their views and raise any concerns. A proactive approach has been taken to safeguard people. Evidence: Feedback in surveys showed that people felt able to tell Mrs Wooderson or their family if they are unhappy, however, two residents said they did not know how to make a complaint. There is a complaints procedure that is on display and each person has been given a copy. People attend a locally run self advocacy group. The home has been the venue for this for the last year. This is likely to move to a new venue soon but Ms Wooderson hopes people will still attend. Staff from the home do not attend this but the facilitator gives feedback where appropriate. People can also raise issues through the residents meetings or when they meet with their keyworkers. Ms Wooderson reported that she has received two complaints in the last year. One was from neighbours about car parking and one was internal between two staff. Both were dealt with promptly. We have not received any complaints about the service. The majority of people have relatives who could advocate on their behalf. The two surveys from relatives reported that they knew how to make a complaint and felt confident that any concerns would be addressed. It would be positive if the use of independent advocates could be developed, particularly if other people are asked by their funding authorities to decide about their future accommodation plans. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Staff have been provided with adult safeguarding training and those spoken with were clear about their duty to report any concerns. One safeguarding matter has been ongoing since before the last inspection. Ms Wooderson has ensured appropriate arrangements are in place in the home. Mr Kidd has been supportive by providing additional resources. They are still waiting for the input from the psychology department of the Community Team that was agreed as part of the strategy meetings action plan. Ms Wooderson confirmed that she is very clear about the local procedures and how these interface with the owners disciplinary procedures. The people spoken with in private said they felt safe in the home. One person has been supported by the home and a social worker to make a difficult personal decision about relationships outside of the home. This has been sensitively managed and he is reportedly now relieved and more self confident. Another safeguarding matter was disclosed by a worker earlier in the year. This was reported under the local procedures and appropriate action was taken to protect people and investigate the concerns. Ms Wooderson showed evidence in staff supervision files that she had followed the agreed plan of action to supervise the workers more closely when they were returned to their duties following the investigation. Staff are being trained and supported to develop a better understanding about peoples behaviours and systems are in place to monitor these. Positive approaches are being used if people become upset and no physical intervention is used. Professional advice has been sought appropriately. Care Homes for Adults (18-65 years) Page 22 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is clean, comfortable and safe and generally meets the needs of the people living there. Work to improve the layout and facilities in the home is due to commence shortly. Evidence: The Home is situated in a rural location in Herefordshire. The detached house is set in large attractive gardens with far reaching views. The location does mean that people are dependant on staff driving them to facilities in Hereford or Leominster. There are public buses coming through the near by village but they do not run very frequently. It is positive that one man is now learning to use the bus independently. The home was warm, bright and in good order. Some areas have been decorated in the last year and the dining room was being painted on the day. The entertainment room in an annex is popular and the second TV lounge upstairs is also used, particularly by a group that like to watch sports. The house is not well adapted for people with physical disabilities. The kitchen doorway is not accessible and the bedrooms and bathroom are all on the first floor. There is a stair lift but this makes the staircase narrow. The bathroom is not designed to be accessible but a removable bathing aid is provided. One person who uses a wheelchair has an ensuite bathroom Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: with an accessible bath. He cannot access the upstairs TV lounge because there are three steps along the corridor. Advice from occupational therapists has been followed including the addition of a ramp at one door and a rail at the top of the stairs. Building work is due to start on providing ground floor en suite bedrooms for three of the residents. This is a very positive development that will bring great benefits for the people concerned. Consideration is being given to how the rest of the building could be changed to provide smaller group living and improved facilities. Currently there are only one communal bathroom, two toilets and one kitchen. Mr Kidd is aware that the National Minimum Standards recommend that adults under 65 years of age should not live in groups larger than ten and each group should have a dedicated staff team. One person showed us their bedroom. She used to share but has now chosen a double bed paid for by the company. She explained the person she used to share with did not like television but she has now got one in her room and is enjoying this. Her room is nicely personalised with photographs. A cleaner is employed on a part time basis. Two areas had an unpleasant odour. Ms Wooderson said one person was due to have the bedroom carpet replaced and a commode has been provided that is helping the person concerned. The laundry area is a large room fitted with suitable equipment and with lots of storage. Arrangements are in place to reduce the risk of cross infection. Care Homes for Adults (18-65 years) Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been staffing problems this year. People are now being supported by a team of staff they like who are appropriately trained and well supported. People are being protected by the recruitment procedures. Evidence: Ms Wooderson reported in the AQAA that the service does the following things well; Provide good staffing ratios. Recruit effectively. Provide staff with regular supervision, and appraisal. Respond to any staffing issues promptly and appropriately. Provide staff with appropriate and regular training. Recognise both publicly and privately staffs good practice, and extra effort. Tell staff what is expected of them and support them to achieve it. The level of staffing has been significantly increased since the change of ownership. At night a waking night worker is provided with another person on call, in case of emergency. In the mornings three staff are on duty, this sometimes includes the manager and in the afternoons and evenings there are four staff. The team now consists of fifteen staff. There have been staffing difficulties during the summer of 2008 due to disciplinary action, sickness and vacancies. Agency staff were used regularly during this period and staff from Mr Kidds other care home covered shifts. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Agency staff are now only being used occasionally and there is a small team of relief staff who can cover gaps. Two seniors have been appointed to strengthen the management arrangements after the deputy was dismissed for misconduct. Several of the staff appointed have previous relevant experience and Ms Wooderson is working hard to develop an effective professional team. Staff meetings are being held regularly and staff are having supervision sessions and annual appraisals. The recruitment records for one new worker were sampled. The file showed that the homes procedure has been followed. Appropriate references and a CRB check had been carried out. Some points of good practice were discussed such as the need to establish why people had left previous work with children or vulnerable adults. The staff feedback confirmed that they have been provided with appropriate training for their role. New staff said they received a thorough induction including shadow shifts and time to read care plans and procedures. Core and specialist training has been provided such as fire drills, epilepsy and equality and diversity. Now the team is fully staffed and settled Ms Wooderson plans to help support workers develop their keyworking skills and the seniors develop their shift leading and supervisors skills. Currently staff are not gaining the Learning Disability Qualification and only one person has an NVQ award in Care. Another has nearly finished the level 3 award and others are due to start. At least fifty percent of the staff should be qualified so this area needs to be focused on in the coming year. Feedback showed that people in the home like the staff and relatives felt they were helpful and well trained. Staff spoken with were positive about the service they provide, they feel they are well supported and said that team morale is good. Care Homes for Adults (18-65 years) Page 26 of 33 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 are benefiting from a well run service that puts their wellbeing and protection at the centre of the decision making process. Evidence: Ms Wooderson has been working as a registered manager for eighteen years in six care homes prior to coming to Moor Court. Five of these services were for people with a learning disability. She gained the Registered Managers Award in 2004 and the NVQ 4 in Care in 2003. She also holds a Certificate in Care Learning Disability and Advanced Management in Care. She has kept up to date in safe working practices and in best practice for people with learning disabilities. For example, she has attended a course on the Mental Capacity Act and has a good understanding of how to put Equality and Diversity into everyday practice. She works regularly on shift and knows peoples needs well. She reported that she has a good working relationship with Mr Kidd who is supportive about the modernisation plans and person centred in his focus. She reported in the AQAA that these areas have been improved; Putting peoples Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: needs at the core of service delivery. Supporting staff to develop and be an effective team. Create and maintain systems which help with management and recording of service provision. Systems have been set up that were not previously in place, such as incident reporting and analysis, complaints register, Keyworker meetings, keyworker reports, accident monitoring. All policies and procedures have been reviewed. Plans for 2009 include, Develop two new senior staff members to be confident in managing the home in compliance with legislative requirements. Carry out refurbishment of the home. Increase peoples opportunities for greater independent living skills through learning plans. Implementing a Quality Assurance programme for service users, staff and stakeholders. The AQAA contained helpful information in many sections but Ms Wooderson did not cover some key standards at all, such as assessment, adult protection and complaints. The AQAA is an important part of the regulation process. It is the tool the providers need to use to demonstrate they are monitoring outcomes for people using their service, and they understand the strengths and areas to further develop. Significant improvements have been made to the service since the change of ownership, despite the challenges that have occurred, and the residents are benefiting from these. Feedback has been very positive and people feel an open culture is being developed. Mr Kidd has been completing monthly monitoring visits and issues have been reported openly to us. Discussions showed that the Regulations, Standards and other relevant guidance was not available in the home. This should be addressed to ensure Mrs Wooderson and the seniors have all the information she needs. A sample of peoples financial records were seen. The information was clear and spending was appropriate, such as opticians and chiropody. Bank statements confirmed that in house records of withdrawals and deposits were accurate. Some people are keeping their money in their bedrooms but others still use the office. A worker said some prefer this so they do not have to go and get their tin when sorting money out with staff. It would be more person centred if staff were to go to peoples bedrooms to assist them with their money. Ms Wooderson has a good understanding of current health and safety legislation and she is supported by the company Mr Kidd uses for advice in this area. There were some gaps in the AQAA about servicing dates for 2008, but these were clarified and found to be in order during the inspection. Safety advice was seen around the home. A bottle of descaler was seen in a toilet. Ms Wooderson said there is no known risk of someone misusing chemicals but it should have been locked away after use. She said she would ensure staff were reminded of the guidance in the COSHH risk assessments. Care Homes for Adults (18-65 years) Page 28 of 33 Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Review the Statement of Purpose and ensure there is a clear vision for the future service. Develop the Service Users Guide and Terms and Conditions of Residence into an accessible format. 2 3 4 2 6 19 Develop an assessment tool to aid the decision making process for the admission of new people. Hold care review meetings at least every six months. Continue work to develop each persons preventative health action plan. Review how decisions are recorded when the person concerned lacks the mental capacity to make the decision themselves. 5 6 20 32 Keep the schedule 3 Controlled Drug in approved CD storage and track its use in a CD register. Staff should be offered the opportunity to gain the Learning Disability Qualification. Care Homes for Adults (18-65 years) Page 31 of 33 At least half the staff team should be supported to gain an NVQ award in Care. 7 37 Continue implementing the improvement plan that has been developed. Obtain copies of all relevant legislation and guidance. 8 9 39 42 Implement a Quality Assurance System that includes consultation with stakeholders. Ensure cleaning chemicals are always held securely unless risk assessment states this is not needed. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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