Care Home: National Star College

What the care home does well New students have access to comprehensive information about the college and the services they are likely to receive. Robust admissions processes include a stay over at the college during `Stars of the Future` week allowing prospective students to test drive the college facilities. Students said the college was, "excellent," "brilliant" and "there are lots of activities, good food, good support network and good facilities." One member of staff said, "I get a massive sense of achievement empowering individuals and giving them a better value of life and an once in a lifetime experience." Students said they were fully involved in the reviews and auditing of the college and felt listened to and able to influence positive change. They had confidence in the complaints procedures. Robust systems were in place to equip students with information about how to stay safe and comprehensive safeguarding procedures were in place. The recruitment and selection systems were excellent making sure that new staff were appointed only after exhaustive checks had been completed. Excellent training programmes were in place from induction through to NVQ programmes and accessing specialist knowledge. The college strives to make sure that the environment is accessible, safe and well maintained. What has improved since the last inspection? One requirement was issued at the last key inspection and this had been complied with, namely that tiles in a bathroom in Shortwood were replaced. Requirements issued at a Random Inspection in 2008 were met in relation to the administration of medication for students going on home leave. A further requirement was carried over in relation to making sure that the storage of controlled drugs complied with the Misuse of Drugs Regulations; this had been implemented. Four other requirements issued at a Random Inspection in July 2009 had also been complied with. New systems had been introduced to provide a more consistent approach to supporting students with their personal and medical health care needs. Nurses had been allocated to each residence and nursing care plans were kept in the residences. What the care home could do better: Some recommendations were made in relation to the administration of medication to ensure that this is robust and students are not at risk of harm. Key inspection report Care homes for adults (18-65 years) Name: Address: National Star College Ullenwood Manor National Star College Ullenwood Cheltenham Glos GL53 9QU     The quality rating for this care home is:   three star excellent 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: Lynne Bennett     Date: 0 3 0 3 2 0 1 0 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 37 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: National Star College Ullenwood Manor National Star College Ullenwood Cheltenham Glos GL53 9QU 01242527631 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: lbarrett@natstar.ac.uk National Star College care home 88 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 88. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability (Code PD) Date of last inspection Brief description of the care home The National Star College is a College of Further Education, providing residential accommodation for students with physical disabilities or acquired brain injuries. The main campus is based at Ullenwood Manor, situated in beautiful grounds, above Cheltenham town centre. The campus is made up of various education buildings, a large sports centre with swimming pool, administrative offices and accommodation areas; all are accessible to people who use wheelchairs. Accommodation is provided in a number of units on site. Wilson Court, is home to 43 students in single bedrooms on two floors, accessed by a shaft lift. There are assisted toilets, bath and shower facilities. The students also have a large lounge with kitchen facilities on the first floor. Care Homes for Adults (18-65 years) Page 4 of 37 88 Over 65 0 Brief description of the care home Cotswold has 12 en-suite single rooms for students who have a high level of need. This has a dining and living room, with a purpose built kitchen. Cotswold also has additional therapy rooms, a relaxation unit, and a large lounge/dining area. The Shortwood complex has been fully refurbished and houses 13 students. There is a kitchen and communal lounge area. A garden flat at the side of the house provides shared accommodation, plus cooking and bathroom facilities for two students. Malvern provides 10 well equipped single rooms, 5 with en-suite facilities, 4 sharing 2 bathrooms and 1 independence flat with en suite. Students also have access to a lounge/diner with kitchen facilities. Cleeve provides single en-suite bedrooms plus dining and lounge facilities for 10 students. The medical base for the campus is in the same building as Cotswold: it has a dedicated sick room and consultation rooms. The provider supplies information about the service, including the most recent CQC report, to students and their advocates on request. The current scale of charges is maintained within the Learning and Skills Council matrix. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place in March 2010 by two inspectors, including visits to the college on 2nd and 3rd March. One of the inspectors was a Pharmacist and his role was to look at the arrangements the home has in place for the management of students medications. The registered manager had completed an AQAA (Annual Quality Assurance Assessment) providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We had received surveys from 6 students, 5 relatives and 14 members of staff. We talked or observed 6 students using the service, and asked staff about those students needs. We also looked at their care plans, medical records and daily notes. This is called case tracking. We also spent time talking to other students observing the care and support they were receiving. We also talked to a group of representatives from each residence. In addition we examined a range of information including staff Care Homes for Adults (18-65 years) Page 6 of 37 files, health and safety and quality assurance audits. Since the last key inspection in 2007 we had completed two Random Inspections in May 2008 and July 2009 in response to notifications we had received. Requirements were issued at these inspections which have been complied with. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students have access to a range of information including visits and a short stay enabling them to make an informed decision about whether they wish attend the college. A comprehensive assessment is completed to make sure that the college is able to meet each students needs and that bespoke equipment is provided for them if necessary. Evidence: Each student is given a copy of the current Service User Guide as part of their induction at the college. The Statement of Purpose is reviewed annually and is available electronically as well as in a hardback version. Students have access to a wealth of information about the college produced both by the college and by students themselves. The college website provides access to the colleges policies and procedures. Comprehensive admission information was obtained for each student prior to starting at the college in September 2009. We examined pre-admission assessments which had been completed by their schools, parents and other health care professionals. This Care Homes for Adults (18-65 years) Page 10 of 37 Evidence: information was then supported by a pre-admission assessment completed by the college again having input from a wide range of social and health care professionals. All students were invited to attend an induction at the college for five days, called Stars of the Future(SOTF). The AQAA stated, Only students that have a confirmed offer of a place for September are now invited to SOTF at Easter to ensure that the most relevant individuals are being assessed and that the assessment is not out dated by time of commencement. Records collated during this induction included observations by care facilitators. The result was that by the time students started their new term at the college information for care plans, support plans, risk assessments and their equipment needs had already been collated to provide a smooth transition to living at the college. The AQAA stated thorough and detailed pre-assessments were in place and that over the past twelve months they had ensured that specialist equipment was in place prior to commencing college, and that future plans included increased working with feeder schools to prepare for residential college. Students we spoke to during our visits said they had settled into the college well with the support of other students and staff. Records indicated that new students were supported by staff to become familiar with the campus and this would only be withdrawn when they were confident in their bearings. Comments from parents of a student included, ..... transition to college life has been handled well and gone smoothly, and one staff survey said, the service always strives to conduct extensive and specific assessments in order to establish what a service user may need in order to live at college during term time and maximises its access to all external sources in order to support meeting that need. Care Homes for Adults (18-65 years) Page 11 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students needs are being assessed and they are being supported to makes decisions about their lifestyles. Excellent systems are in place to enable students to communicate their wishes and to make information accessible to them. Risks are being managed safeguarding from possible harm. Evidence: The college were exploring new ways of presenting care plans and support plans for future use, promoting personalisation, reducing duplication and using more efficient systems including new technologies. At the time of our visits each student had core care plans supplemented by additional care plans, personal development targets and risk assessments. We case tracked the care of a student living in each residence and sampled other files. Care plans reflected students assessed needs and were personalised clearly reflecting how they wished to be supported with their personal and medical care. Separate core care plans and medical risk assessments provided clear and specific information about the support needed by the student to ensure their health, safety and well being. These records were being reviewed formally at least Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: once each term and with students as part of their monthly key worker meetings. Daily records (ILS) commented on what students had done each day, how their personal, medical and nutritional needs had been met and whether they had needed any medical interventions. Students sign records on their files or have witnesses to sign for them. Each student had care plans and risk assessments in their rooms. Some were displayed on walls but most were kept inside students wardrobes respecting their rights to confidentiality. Personal development plans indicated how students were being supported to develop their independence in such areas as community skills, social or recreational activities, self medicating or developing culinary skills. Students were observed working towards these targets during our visits. One student had prepared a meal and another was using the computer to keep a diary. Staff said the Personal Development sessions had been extended to a full day enabling students to take full advantage of the session both on campus and off site. Excellent use was made of photographs and pictures around the campus to illustrate information including menus, staff rotas, students living in each residence and policies and procedures. Students said they found the photo board in the hallway of their residence really useful providing them with accessible information about which staff were working each shift. All residences have access to a computer in communal areas and also have access to wireless connections. Some students have communication tools such as bliss boards, lite writers or eye/gaze activated communicators. Some rooms were fitted with possum environmental controls. Students have access to a college speech and language therapy department. An ex student was being employed to run an advocacy service on site, having identified the need for this when a student at the college. SPEAK was being sponsored by a local business person. Students we met spoke positively about this resource. They had access to information about this in their student handbook and on the internet site. Any restraints or restrictions to students freedoms such as the use of lap belts, bed sides and listening monitors were noted in their care plans describing the rationale for the use of these, to protect students from possible harm. Students or their representatives had been asked to sign consent forms in relation to these restrictions or restraints. Comprehensive risk assessments were in place for each student alongside medical risk assessments. Moving and handling risk assessments were clear and specific about the Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: procedure, numbers of staff and equipment needed for each moving and handling task. Robust assessments were in place for students accessing the community providing staff support until they had gained a community passport enabling them to be independent. Likewise students were supported to gain confidence using electric wheelchairs around the site with staff support as long as this was needed. Risk assessments were being reviewed regularly. Care Homes for Adults (18-65 years) Page 14 of 37 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. Students make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. Students have a nutritional diet and their diverse needs are catered for. Evidence: The AQAA stated, We support students to attend churches of their choice and we have our own college chaplain who offers a service every Sunday. Records were inconsistent when identifying students spiritual beliefs, with some residences using a Faith and Belief proforma which in some cases provided comprehensive information about the students beliefs and the way in which they wished to be supported. These were also in place for students who had not expressed any religious or spiritual needs. The chef stated that if students had any particular dietary requirements in respect of their religious or spiritual beliefs then these would be catered for. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: Students surveys said, there are lots of activities, we go to courses, trips and spend time outside of lectures doing what I want to do, and would like more staff and more trips. Surveys from relatives and staff also indicated that some students missed out on opportunities to go out due to staff shortages or students refusing offered activities being left unsupervised. The AQAA stated the college offers excellent leisure provision and opportunities. Staff commented, we organise and support leisure activities and we could provide more night activities in the community. ILS records we examined provided evidence that students were regularly having access to a range of social and recreational activities and opportunities both on the campus and in the community. Since our last inspection there were more staff who were able to drive the colleges range of vehicles increasing opportunities for off site activities. Management stated that at least one vehicle each evening provided the opportunity for students to access the local community and there were greater opportunities at the weekends. Records indicated students were going out to the cinema, clubs, shopping and to restaurants. Day trips were also being arranged to football matches, concerts and the theatre. Where students had been offered activities and declined this was being recorded. During discussions with the student representatives they indicated that they would like to see more access to activities off campus particularly for those students needing the support of staff. Leisure facilitators were in post to provide support to students at evenings and weekends. The senior management team said they were constantly monitoring and reviewing recreational and social opportunities for students. They said they tried to strike a balance between supporting students to access social and recreational activities whilst empowering them to be as independent as possible. Surveys from staff indicated that better facilities could be made available for students wishing to gain independence managing their laundry. Management said that where facilities in some residences were inadequate students could use other residences. This was also applicable to the kitchens which in some residences had high/low surfaces and were better equipped for students using wheelchairs. Students personal development goals enabled them to become independent in a number of areas including doing their laundry, planning and cooking meals, community activities and self medication. Students were being supported to try out work placements both within the college and off site such as at a nursery. Last year 28 students were involved in volunteering locally. An ex-student had been employed by the college to set up an advocacy service. Students were involved in the recruitment and selection of staff, training and Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: had student forums which directly linked to the senior management team. Students spoken with said they were encouraged to express their views, were listened to and thought the college was responsive to them. The AQAA stated,Students set their house rules in liaison with each other and the management of their residence as well as their student rep. Students said that their family and friends were welcome to visit them at the college and there were facilities to meet and greet with them in private if they wished. Students had access to computers in communal areas in their residences which were also fitted out with a wireless network so they could access email in their rooms. ILS records for one student indicated that their key worker (with their permission) kept close contact with their family via email and telephone. Some residences had provided electronic keys to students enabling them to lock their rooms if they wished. A student survey commented that the smoking area was too close to the medical centre. Staff and students were not observed smoking in the grounds during our visits. Meals and snacks are provided in the main dining room, Star Bar and residences. Students decide where they wish to eat. One student said that they have information in their residence about the menu for the day in the main dining room and can choose if they wish to eat their meal in the dining room or have it brought over to their residence. Staff said that meals were transported in insulated containers and were not being re-heated. The residences were not supplied with hot food probes in case meals needed to be re-heated. Any re-heated food must be tested to make sure it has reached the correct temperature which needs to be recorded. Feedback about the quality of food provided was mixed with some students saying it was excellent, good quality and others saying portions could be bigger or the food was too rich. The chef described how the menu had been developed to provide students with freshly prepared meals using locally sourced produce of a high standard and promoting a nutritional diet. Menus evidenced which meals would provide access to Omega 3 oils and offered a choice of hot and cold meals. We discussed how peoples individual dietary requirements were met including soft diets which were produced tastefully. Specialist diets such as diabetic, celiac and allergies were catered for. An aide memoir in the kitchen helps staff to guide students towards their preferred diet. The chef explained how meals often reflected different cultures and religious festivals and celebrations such as Chinese New Year. An environmental health inspection of the kitchen the day before our visit awarded the kitchen five stars. Information about meals, menus and the breakfast club were displayed around the main dining room making good use of photographs and pictures to illustrate text and make them Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: accessible to all students. Water and squash dispensers were provided in residences and around the college. Students said they can access snacks from the Star Bar and will often use this facility if they do not like the menu in the main dining room. Student representatives said they were attending the second catering meeting with the chef during our visit and would highlight any concerns they have about the menu. Students were observed being supported to prepare and cook a meal as part of their personal development goals. Care Homes for Adults (18-65 years) Page 18 of 37 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. Personal care support is offered in a way that responds to peoples needs and preferences, promoting peoples dignity. There are generally safe arrangements in place for the management of medicines although there are a few areas for improvement which we are confident the college can quickly and easily address. Evidence: The way in which students would like to be supported with their personal and health care needs were clearly recorded in their care plans. These were personalised and provided specific information about how the student wishes to be supported with their personal care. An assessment for one student identified that they had requested that a male care facilitator provided personal care. This information was not recorded in their care plan. Daily notes indicated that they had discussed with their carer why this was not being provided. We discussed with senior management that all students should be asked if they have a preference about the gender of staff providing their personal care and that wherever possible this should be respected. Their care plans should also reflect this. Since our last visit to the college, core care plans and medical risk assessments had been moved from the nurses office to the residence. Each residence also had two named nurses allocated to each residence. Care facilitators Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: said this was working really well and they felt more confident when supporting students with more complex needs. Nurses also said that although they no longer knew everyone on campus they had developed a deeper understanding of the students under their care and were able to provide more support to care facilitators including training where needed. Greater care is needed to make sure that evidence is provided to verify that practice is taking place in line with core care plans. For instance some plans stated that the student needed to be moved at least 4 times a day, or needed to have a minimum of 1000mls of fluid. ILS in some residences provided comprehensive records verifying that the student had received the correct fluids or been re-positioned. This was not however consistent across all residences. Risk assessments were in place for those students with tissue viability concerns. These cross referenced with plans for nutrition and maintaining a healthy diet. Comprehensive records were being maintained by nurses when students had developed pressure sores, including body maps and photographic evidence. A range of equipment and specialist adaptations were being provided to minimise the risk of students developing pressure sores. Some ILS records indicated that students were being offered bed rest or a change of seating during their day. Care plans and risk assessments were also in place for students with epilepsy. Consent forms indicated that they had agreed to have listening devices or bed-sides in situ to safeguard them from possible harm. Where students had preferred to have regular night checks consent forms had also been signed and monitoring records indicated these were being done. Students have access to a General Practitioner at the campus and 24 hour support of nurses. They were also able to access other health care professionals such as an occupational therapist, physiotherapist, speech and language therapist and the talk to team (psychology). Students usually retain the service of other health care professionals in their home location. Records of appointments were being recorded in significant conversation records on their files. Pharmacist inspectors report about arrangements for the handling of medicines found on 3rd March 2010. As a part of this key inspection one of our (the Care Quality Commission) pharmacist inspectors specifically examined some of the arrangements for the handling of medicines. We looked at some stocks and storage arrangements for medicines and various records about medicines. We discussed in detail with the nursing services manager various aspects of the medicine arrangements in the college. We spoke to two of the nurses on duty. We visited some bedrooms in various areas and spoke to Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: carers there. We observed nurses giving some medicines to students in the medical centre. The inspection took place over a six hour period on a Wednesday. We last inspected some of the arrangements for medicines in May 2008 when we made two requirements and three recommendations in response to weaknesses we identified. At this latest inspection we saw that these requirements and recommendations had been actioned. For example the college have introduced revised systems for providing accurate information about medicines when students go on leave from college and for keeping account of the medicines. The system has recently been revised again so that the medicines and directions were printed directly on to a form from the prescribing computer system as this provided the best way to make sure the information was totally up to date. We noted that some more development was needed with this new system to make sure there was consistency in keeping records for medicines returned by students following periods of leave as part of keeping a full audit trail of the medicines. The college have notified us about relevant incidents with medicines and during 2009 we were told about six such events. We discussed these with the nursing services manager and were satisfied that the right sort of actions were taken to follow up on these and if necessary make changes to reduce risks of similar occurrences. The nursing services manager with a team of nurses based in the college medical centre take the lead for making sure there are safe arrangements for managing and administering medicines for the students in the college. Students are registered with the college doctor and there are regular surgeries each week in the medical centre. Staff supported about 25 students to self medicate in various ways. There was a comprehensive self medication training programme in place to equip students to deal with their medicines independently and thus help them with their independence when they leave college. This is good practice. We looked at some records for three of these students. Some of the records about the medicines staff handed to these students to look after were missing and there was variation about where this record should be kept. This sort of information should be clearly defined in procedures so that all staff can understand what they need to record. Students who self administered their medicines were provided with locked cupboards in their bedrooms in which to keep their medicines safely. In one bedroom we visited the cupboard was not fixed as staff told us the student had just moved rooms. They were making arrangements to have this cupboard screwed to the wall that afternoon. In other bedrooms we visited these cupboards were secured to the wall. Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: For those students who did not self medicate, most medicine administration was undertaken by the registered nurses. The students were given choices about how they take their medicines and there were arrangements to be sensitive about the gender of staff providing certain personal care tasks. The nursing services manager told us about how they respond to any equality and diversity matters that may affect medicines such as supporting a student who had wished to fast for a religious festival or respecting choice for homeopathic products. We looked at some of the arrangements for recording medicines to check that students were not at risk from mistakes with their medicines because of poor records and that there were full accounts of the medicines the college was responsible for on behalf of the students. Accurate, clear and complete records about medicines are very important in a college like this where often each student takes a number of different medicines and various staff throughout the week will be responsible for medicines. The pharmacy provided printed medicine charts each month on which to keep records of the medicines prescribed, received and administered. The space provided to record allergies on the medicine charts was completed where students had a known allergy but otherwise was left blank. It would be good practice to include none known in this section on the medicine chart rather than leaving it blank as an indication that this important issue has been considered. We saw separately a full list of allergy information for each student. We looked in more detail at some medicine administration records for seven students. We found these were generally up to date and showed what medicines had been administered. A standard code letter was printed on the charts for staff to select appropriately to explain if a dose was not given for any reason. For one person we saw that the code letter O was used meaning other but no explanation for other was provided. Some improvements were needed in keeping records about the topical application of some prescribed medicines (such as creams, ointments, lotions). There were not always consistent or up to date records for all of these. There needs to be a defined way to make sure that these prescribed treatments are used correctly, that staff have clear information about this and that records clearly demonstrate what treatment has been provided. We have published information about this on our website (www.cqc.org.uk Pharmacy tip 9 - Administration and recording of creams and nutritional supplements). We saw good practice where a body map was used to help record the skin care given Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: to one student. The tub of cream used for this student had a date when first opened to use in October 2009. The in use period for this type of product was four weeks from opening in order to reduce risks of contamination. There was a list of information about the periods different medicines should be used after opening in the medical centre. Staff need to be aware of this information and make sure this is adhered to. We checked some eye drops and found these were being used for the right periods. Some students were prescribed medicines to use when required. We saw there was information in place if these medicines were to treat conditions such as constipation or epilepsy. Other medicines had directions to use if upset, for migraine or for severe restlessness. Sometimes the medicine charts had extra information printed which was helpful but it is good practice to have full written guidance in some way for staff about how to make a decision about when or what dose of this type of medicine was needed, or if the student was able to say when they needed the medicine. The provisions of the Mental Capacity Act 2005 must be taken into account particularly if students could lack capacity to understand or consent to their medicines. Having this sort of guidance helps to make sure that there is some consistency and agreed actions to meet the students individual needs. Some students were prescribed enteral feeds that were given through a tube. We saw there was information about caring for these students and a community dietician also supported these students. One of the nurses took a lead on this treatment and provided training to those carers who supported these students. We did not always find that there were records that should be in place about the feeds administered each day. This is an important record to demonstrate the student is getting the feeds as prescribed. Where some other students had prescribed food supplements that they had as a drink we saw this information was recorded on the medicine charts. We have published information about this on our website (www.cqc.org.uk Pharmacy tip 9 Administration and recording of creams and nutritional supplements). One of the enteral feeds for one person had been out of stock for four days. One of the nurses had taken appropriate action to quickly organise a further supply and use an alternative similar product until the new stock was delivered (which happened on the day of our inspection). There were safe arrangements for storing medicines in locked cupboards and medicine trolleys. We were concerned that one medicine trolley in particular we looked at was very full and although medicines were organised by alphabetical order of student name this resulted in several medicines for a number of students being mixed together. It is normal practice for medicines for each person to be segregated together in individual compartments on a medicine trolley. This helps to make selection of the Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: medicines for an individual person easier and can reduce risks of selecting the wrong medicine. Some of the incidents notified to us last year involved selection of a wrong medicine so this issue should be given serious further consideration. An additional or alternative design of medicine trolley may be appropriate to consider for example. We advised in one medicine cupboard that products which are applied to the skin should be stored below any medicines that are swallowed so as to avoid contamination should there be any spillage. There was a designated locked medicine fridge to keep those items needing fridge storage. Daily records were kept of the temperature which showed this was in the correct range. We advised how to reset the maximum and minimum thermometer each day so that the range of temperature in the previous 24 hours can be easily seen. It is not hygienic to keep specimens in this fridge as we found. We found improvements in the arrangements for managing controlled drugs since our last inspection of medicines in 2008. The requirements and recommendations made at this time have been put in place and there are safe storage and recording arrangements for this group of medicines. There were suitable arrangements in place with a waste disposal company for dealing with medicines no longer required and records were kept for these. Staff must be clear that any controlled drugs that are no longer needed must also be disposed of in accordance with the Special Waste Regulations 1996. We have published information about this on our website (www.cqc.org.uk; Safe disposal of medicines from care homes, nursing). There were arrangements in place to audit and check medicines and records each month, the last recorded check being the week before our inspection. This was part of a four week cycle of audits and checks of various equipment and systems within the medical centre and is good practice. In the college policy file (2009 version) was a draft administration of medicines policy dated January 2008. This consisted of two pages of policy statements. It was not clear to us why this was still a draft. We also saw in the medical centre there was some written guidance about certain aspects of medicine arrangements. We discussed with the nursing services manager about supporting the medicine policy statements with written procedures and practice guidance for all aspects of handling medicines that explain to any staff involved with medicines what to do and how the college expects them to do this safely. Some of the arrangements for handling medicines in the college were quite complicated so clear procedures would be helpful in making sure staff understand what is expected. Some of the points raised in this report may Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: perhaps be partly addressed by making sure clear procedures are in place that everyone understands and follow. A more accountable system is needed for some prescriptions forms held in the medical centre. There were suitable homely remedy arrangements in place so that the nurses could assist students with treatment for some minor ailments. Student specific directions were also in place for the provision of a few antibiotics should students require these at short notice. Care Homes for Adults (18-65 years) Page 25 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is in place to enable students to express their concerns and they are confident that they will be listened to. Robust systems are in place to safeguard students from possible harm or abuse. Evidence: The complaints procedure was accessible to students in a variety of ways. The students handbook provides a summary of the complaints procedure which was also displayed around residences and in some students rooms. It is also accessible on the college web site. Students spoken with said there were lots of different forums in which to talk about concerns. Each residence had a student representative who met collectively and fedback to senior management. Students could also attend a full meeting of the students union. They said that catering meetings had recently started and they also had representatives on the health and safety committee. Students spoken with said they felt listened to, respected and that they could effect positive change. Students are also part of the colleges quality assurance process and their perceptions then become part of the colleges annual self assessment report. Key changes as a result of this process affected changes to timetables and transport timings for college. The college had received 13 complaints over the last twelve months of which 1 was upheld and 1 was ongoing at the time of our inspection. We had not directly received any complaints about the college but were aware of 1 complaint before our visits. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: The college has robust systems in place for the identifying and reporting of suspected abuse. Staff we spoke to had a good understanding of the safeguarding procedures and the dedicated team who deal with any concerns or allegations. All staff completed safeguarding training as part of their induction, which includes child protection training. They also have access to refresher training in the form of the safeguarding toolbox which is a short course using case studies. The colleges self assessment report stated, the college promotes a culture of respect and openness and complies with health and safety and child protection legislation. It also stated that in a feedback session 92 per cent of students said they had learned enough to stay safe and their responses indicate a good understanding of key issues. Students are advised about staying safe when using the internet and accessing the community as well as safe talk about relationships. Staff were completing training in Boundaries as well as the alerters guide (familiarising them with the local procedures). All care facilitators were taking part in care audits which involved observation of their practice. Robust recruitment and selection procedures were in place, with evidence that references were being monitored, questioned and researched before staff were offered a position at the college. The college has close links with the local adult protection team. The self-assessment report for 08-09 identified areas in which a good safeguarding practice could be further enhanced. The training team and the talk to team have developed a new programme of five individual stand alone training units in the management of challenging behaviour. It is intended that staff can pick which stages are relevant to them in their work rather than working through the five stages. Care facilitators confirmed that they had access to the first stage as part of their induction. Where there are concerns about anxious students or those who have anger management problems they can receive support from the talk to team. Guidelines for staff to support them to manage their anxieties were in place. A team email system can also be implemented to make sure all staff are working consistently. Students had financial assessments in place and personal financial records indicating when they had access to their money. These were being audited and signed to indicate money transfers. Students had secure facilities in their rooms in which to keep their valuables if they wish. Inventories were in place for students personal possessions. Care Homes for Adults (18-65 years) Page 27 of 37 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. Students live in residences that are safe, clean and well maintained which recognise their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those students who need it. Evidence: There are five residences on campus, four of which have been purpose built for students. Wilson Court which currently houses up to 43 students is due to be replaced by purpose built accommodation on site. The first of these is due for completion in February 2010 providing accommodation for 10 students. Wilson Court will continue to provide facilities for students yet to be fully determined. Until then the accommodation provided at the unit is being maintained and has been substantially improved since our last inspection. Some students living there spoke positively about the facilities and the sociable atmosphere. We walked around all residences and some students showed us their rooms. Students are assessed for their equipment needs and any specialist adaptations that are required prior to starting at college. Overhead tracking, possum environmental controls and assisted baths are supplied in some residences. Some students have rooms with en suite facilities. Occasionally a student may share a double room which is always provided with a privacy screen. Only students who agree to double rooms will be allocated these. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: Staff said the day to day maintenance of the residences is good. Systems are in place identifying issues which the maintenance team will address immediately where-ever possible. Long term re-decoration or refurbishment is normally completed during student holidays. Most residences had dedicated cleaners who maintain good levels of cleanliness. During our visits staff were cleaning Shortwood. A cleaner had been appointed for the unit and was due to start work soon. Surveys commented that rooms are unorganised and often dirty, and equipment is not cleaned enough. However during our visits the residences and equipment were satisfactory. During our visits we noted that a ceiling in Shortwood had a large brown stain. This will need investigating and making good. Communal areas around Shortwood such as door frames and skirting boards were also damaged. The manager said these would be attended to during the next student break. Laundry facilities are provided throughout the campus and control of infection protocols were being followed. A temporary laundry for Wilson Court has been situated in a porta-cabin (due to be re-sited in a new build) and the laundry person must be commended for maintaining the service in less than satisfactory conditions. Hand gel was provided in communal areas around the site as well as personal protective equipment for staff. Clinical waste is dealt with appropriately. Care Homes for Adults (18-65 years) Page 29 of 37 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of students. A robust recruitment and selection process is in place which should safeguard students from possible harm. Evidence: Student surveys said, staff are very supportive to the students and do their utmost to assist the students in all aspects of their life. Students spoken with said that staff were excellent, absolutely wonderful, they understand my needs, brilliant and great people. All new staff were completing an induction which was equivalent to the Skills for Care common induction standards. The colleges self assessment stated, A very effective and wide ranging multi-disciplinary initial assessment and induction programme is delivered by well trained staff. During induction care facilitators have named mentors. Staff said once they completed their induction they then progressed onto the National Vocational Qualification (NVQ) programme. The AQAA indicated that the majority of staff have either a NVQ or are working towards it. The AQAA stated, We promote the Colleges values and ethos, eg promoting independence, dignity, respect and the rights of the individual, and We foster a team spirit which recognises the diverse roles and responsibilities of individuals. Discussions with staff during our visits confirmed this. The college has a system of care audits in place where Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: management or the training department observe staff during their working day. The outcome of this audit is then referred to in support and development sessions and as part of the annual appraisal process. We looked at new files for 6 members of staff and sampled others. Recruitment and selection was administered through a central department and comprehensive and robust records were being kept for all new staff. Files had a front sheet providing evidence of when records or information had been requested and received. Each person had an application form in their file which provided an employment history. Where there were gaps in this they were being explored and evidence recorded to provide a full employment history. Excellent systems were in place to research and explore references at times verifying them verbally with previous employers. Most staff had provided at least 3 references. Where references could not be obtained the reasons for this were clearly recorded noting all attempts to obtain these. Where people had worked previously in care the reason for leaving this employment was being obtained. Evidence of identity was in place including a current photograph. Copies of birth certificates should not be kept in line with Data Protection recommendations. Copies of training certificates were being obtained to verify staff training records. As previously mentioned students are actively involved in the recruitment and selection of staff. The college has a Continuing Professional Development department and also uses external trainers and courses where needed. Staff said that training was excellent and there are opportunities for staff development. We were shown tool box training kits which the training team use to deliver short sessions to groups of staff. Training delivered ranged from mandatory training to equality and diversity, sexuality, plain speaking and makaton awareness. Staff said they were also able to access training externally. Comprehensive records were being maintained for all staff including personal files in residences confirming training completed and a training database indicating when refresher training was due. Care Homes for Adults (18-65 years) Page 31 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students benefit from an experienced and skilled management team providing a well run establishment. They are fully involved in the quality assurance process enabling them to give feedback and shape the services they receive. Robust systems for the monitoring of health and safety around the site should safeguard students from possible harm. Evidence: The registered manager has a NVQ at levels 2,3 and 4 and the Registered Managers Award. She has completed the Certificate in Management Studies and is a qualified NVQ Assessor. She has considerable experience in this area of care. She completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). In addition she supplied supporting information to evidence the AQAA. She is supported by an experienced and skilled management team overseeing the running of residences on site and is part of the senior management team of the college. Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: Staff and management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Students have access to advocacy and would be appointed an IMCA (Independent Mental Capacity Advocate) if needed. No one in the college was subject to a Deprivation of Liberty Safeguard at the time of the inspection. The college has a robust quality assurance system in place which involves feedback from students including student and stakeholder feedback throughout the college year. Students have representatives in each residence, can participate in student union meetings, have representatives on the catering and health and safety committee and have a Student Parliament which meets with senior management. The self assessment report stated, meetings allow issues to be raised, actioned and feedback on improvements reported. There is a whole college approach to quality improvement with good review and support systems for both staff and students. Staff and students have high aspirations. In addition to these other formal auditing systems are in place monitoring the provision of care and supporting records, training, supervision and support for staff, the environment, kitchen and health and safety audits. As mentioned care audits are also conducted. Monthly unannounced visits to the college were being carried out and a record maintained in line with our requirements under Regulation 26. Robust systems are in place for the monitoring of health and safety around the site. We met with the Estates Department and examined records confirming information supplied with the AQAA that routine checks were in place to monitor fire systems, water temperatures, Legionella risks and equipment. A fire risk assessment was in place and evacuation procedures tested during frequent drills each term. Evaluations of drills were taking place with changes to systems made where issues arose. For instance each residence had a first response system which has been amended to first response of senior person in the residence in recognition that the first person on the scene may not always be the most experienced. Equipment such as ski/sliding sheets and evacuation chairs have been tested. Night time evacuations also take place. Comprehensive environmental risk assessments were in place. Major building work is taking place on site and it was evident that new pathways had been put in place enabling students to continue to access all areas of the site safely. The building site was also being totally enclosed by fencing during our visits. Care Homes for Adults (18-65 years) Page 33 of 37 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 34 of 37 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 13 If food is re-heated, the temperature needs to be taken and recorded to verify it was re-heated to the correct temperature. Review and update the medicine policy and provide with this operational procedures about all aspects for the management and handling of medicines that reflect the specific arrangements in the college so that staff have access to good information about the way in which they are expected to handle medicines. Make arrangements to keep the medicine trolleys well organised with adequate space so that each students medicines are clearly segregated in separate compartments and so help to reduce risks of selecting the wrong medicine. Make arrangements to include an appropriate entry in the allergy section on all medicine administration records as an additional action that can reduce the risk of students being supplied with a medicine to which they are known to be allergic. Review medicine records and care plans for students to Page 35 of 37 2 20 3 20 4 20 5 20 Care Homes for Adults (18-65 years) 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 make sure that any medicines prescribed with a direction when required have clear, up to date written guidance available to staff that clearly describe how to reach a decision to administer the medicine at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. 6 20 Review certain aspects of the medicine recording arrangements to be sure that these always include accurate, clear and complete records for all prescribed topical medicines applied to the skin, all prescribed enteral feeds taken and any medicines given to students to look after as part of their self medication programme. This is to help make sure all medicines are accounted for, that records clearly demonstrate that students receive their prescribed treatments correctly and are not at risk of mistakes because of insufficient recording arrangements. The environmental issues identified in Shortwood should be addressed. Copies of birth certificates should not be kept. 7 8 24 34 Care Homes for Adults (18-65 years) Page 36 of 37 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. 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. 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