Care Home: New Court Place

What the care home does well The AQAA states, "What our service does well is to provide good quality care to people with complex needs by minimising the effects of their disabilities whilst striving to optimum health. We provide a service where individuals have a voice and are encouraged to use it. We provide a service where all service users are recognised as individuals and are supported to be part of their families. All residents are supported to maintain their independence in all aspects of their life. Most residents will need support to do this but they are able to choose how they wish to do this." This was confirmed by the views of the residents and staff who completed surveys for the inspection, and who we spoke to during our visit to the home. All the residents who completed a survey gave positive responses to the questions about their lives in the home and the care they receive. One person said, "I am very happy at New Court Place." Another said, "I am really happy here and don`t want to move." The people who spoke to the EBE all said that they are supported to make decisions about what they want to do. A typical comment from a staff survey was, "The home is very good at meeting the needs of all residents. It caters well to everyone, and responds well to any issues. There is great teamwork within the staff, and good communication." The home provides a good quality of personal care and health care. There is good relationship between the staff and the people who live in the home. The staff are aware of each person`s individual needs and preferences, and they support them to make appropriate choices and decisions about their lives in the home. The home has very robust procedures for administering and recording medication. There is a very good system of regular medication audits that include reconciliation of stocks and administration records, and concentrate on where problems have been in the past. This ensures that people receive the medication that is prescribed for them in a safe way. What has improved since the last inspection? When the pharmacist inspector visited the home in November 2009, he found that the majority of medication was stored securely for the protection of residents. In general the records for ordering and administering medication were in good order and demonstrated that people receive their medicines as prescribed. The home carried out regular checks on the accuracy of medication records and the pharmacist inspector commended this as good practice. On this occasion we found further improvements to the procedures for administering, recording and auditing the medication practices. The Statement of Purpose and Service Users Guide have been updated, and copies are ready to be placed in each resident`s room. They provide adequate information so that people who are thinking of moving to the home can make an informed choice. What the care home could do better: The AQAA stated, "We continue to achieve our goals of moving our service users into independent living accommodation in the community, we have been successful due to our commitment of providing a high standard of care." We are confident that the management team will continue to be proactive in ensuring that the home meets the changing needs of people who live there. Key inspection report Care homes for adults (18-65 years) Name: Address: New Court Place 99 Whitehouse Avenue Borehamwood Hertfordshire WD6 1HB     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: Claire Farrier     Date: 0 1 0 4 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 30 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 30 Information about the care home Name of care home: Address: New Court Place 99 Whitehouse Avenue Borehamwood Hertfordshire WD6 1HB 02082386990 02082386991 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.livability.org.uk Livability Name of registered manager (if applicable) Elizabeth Wehrle Type of registration: Number of places registered: care home 24 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: 24 The registered person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability - Code PD Date of last inspection Brief description of the care home New Court Place is a care home with nursing, providing accommodation and care for 24 adults between the ages of 18 and 65 years of age who have physical disabilities. It is owned by Livability, which is a voluntary organisation. New Court Place is a three storey purpose built building. It is located in a quiet residential area of Borehamwood, about a quarter of a mile from the town. The home has been built and fitted out to high specifications that exceed those required by Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 24 Brief description of the care home National Minimum Standards. The accommodation is arranged in three units on the ground and first floor that are designed to resemble an indoor street, and each resident has a large self-contained studio, with a kitchenette and ensuite shower room. The home has a patio garden accessed from the ground floor dining room. The home is fully accessible for the people who live there. The Statement of Purpose and Service Users Guide provide information about the home for referring professionals and prospective clients. Information on the fees charged was not available on this occasion. Care Homes for Adults (18-65 years) Page 5 of 30 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: In November 2009 the Commissions pharmacist inspector visited New Court Place to assess progress towards meeting some of the requirements made at the last key inspection. On this occasion we spent one day at the home, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We were helped by an Expert by Experience (EBE). This is a person who has a physical disability. She talked to some of the people in the home and gave us a report of her observations. Nine members of staff and eight people who live in the home completed surveys before our visit to the home, and we have used some of their comments in this report. These give a representation of what the people who live in New Court Place think about the home. We also talked to some of the staff and the manager and we looked around the home. We looked at some of the records kept in the home. We also looked at a sample Care Homes for Adults (18-65 years) Page 6 of 30 of care plans so that we could see how people are involved in planning their own care and support. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CQC before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The AQAA stated, We continue to achieve our goals of moving our service users into independent living accommodation in the community, we have been successful due to our commitment of providing a high standard of care. We are confident that the management team will continue to be proactive in ensuring Care Homes for Adults (18-65 years) Page 8 of 30 that the home meets the changing needs of people who live there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each persons care needs. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, A range of assessments are made prior to admission depending on the individuals needs in conjunction with the care assessments from the care management team and others. An assessment of aids is made to ensure the appropriate equipment is available prior to admission or on arrival. Advice is sought from other health practitioners as required and appropriate care package handovers can be arranged and training in place if required. Whenever possible the prospective resident is allocated a named nurse/keyworker during the pre-admission period so that relationships can be formed and developed during this time, making admission less stressful. It also offers families a link point at an early stage in the admission programme. Six people have been admitted to New Court Place during the last year. We saw the assessment for one person who had recently moved into the home. It contained details of all areas of the persons personal and health care needs, their medication, diet plan, communication, moving and handling, Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: and also of their likes and dislikes, interests and hobbies. A preliminary care plan was drawn up that included information on the persons behaviours, when they were likely to happen, and procedures for management; and for their communication, such as objects of reference, body language and behaviour. This provided staff with sufficient information so that they could meet the persons needs while they carried out a full assessment and full care plan. All the residents who completed surveys for the inspection and who we spoke to said that the staff are competent to meet their needs. One person commented in a survey,They do well in all aspects of care. The home has a stable staff team with access to appropriate training, and most of the staff who completed surveys said that they have sufficient information so that they can meet the needs of the people who live in the home. A typical comment in the surveys was, The home is very good at meeting the needs of all residents. It caters well to everyone, and responds well to any issues. There is great teamwork within the staff, and good communication. The Statement of Purpose and Service Users Guide have been updated, and copies are ready to be placed in each residents room. They provide adequate information so that people who are thinking of moving to the home can make an informed choice. Care Homes for Adults (18-65 years) Page 12 of 30 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. The people who live in the home are actively involved in planning their own care and are consulted on every aspect of community life in the home. Evidence: With regard to equality and diversity the manager stated in the AQAA, We believe that every person has value, dignity and purpose and has the right to be treated justly, with integrity and compassion. We aim to encourage people to fulfil their potential - physically, emotionally, intellectually, spiritually, socially - and being valued in their diversity. We believe that we all have responsibility towards each other in this, particularly towards those who are more vulnerable in society. We believe that everyone has the ability and the right to make informed choices about lives, and responsibilities in doing so. We are committed to empowering those with whom we work to be able to make those choices. The care plans that we saw were written in a person centred style that emphasises each persons choices. For example, Every effort should be made to meet (the persons) choice of care. Discuss with (the person) how and when the bath, shower, wash will be done. There are good details of the Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: procedures for each persons care needs. One person uses a communication board. Their care plan states, People should talk normally to (the person) and have the patience to let them create sentences on the board without interruption. We used this information during the inspection when we spoke to the person. The care plans are maintained by computer, and the care staff and nursing staff are able to add the details of the care provided each day and to update them as required. The staff who we spoke to said that the care plans are easy to use, and provide them with good information on each persons needs. We looked at the care plans of two people, and the evidence of care provided for them was tracked through their records. Everyone has a moving and handling assessment, and appropriate risk assessments are in place to support people to take part in their choice of activities. The Annual Quality Assurance Assessment (AQAA) states that people are consulted on all aspects of their care and are involved in formulating their care plan. They are made aware that they can change their mind and and encouraged to discuss this with their keyworker if necessary. The expert by experience (EBE) spoke to six people, and all said that they were supported to make decisions about what they wanted to do. One person who spoke to the EBE was independent enough to make their choices fully without assistance. The residents organise frequent meetings where all residents are encouraged to attend and discuss the home and any issues that are causing concern. The AQAA stated, As a result of residents meetings we planned more trips and outings for our residents which many have enjoyed already with more to come. We have also changed our menus at the residents request. We have refurbished seven residents rooms and have consulted with each resident of their choice of decor and colour they wish. We have decorated the communal lounge area and reception moving away from the bold dark colours to light pastel colours to introduce more light. The residents chose the colours used. Care Homes for Adults (18-65 years) Page 14 of 30 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. The people who live in the home are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, We provide an imaginative and creative recreational activities programmes which meet the needs of our service users, it offers the individual choices and support with a number of them attending college on a regular basis for various courses including Art, Wheel-chair dancing, computer, drama Reading and Budget Skills. Activities are organised across the seven-day week, and an information board that displays the activities within the home. Several residents used the computers for Internet access and playing games during our visit. New Court Place has its own Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: wheelchair accessible transport to take individual service users or groups to events, and a new activities co-ordinator has been appointed who is able to drive the homes minibus, so that more outings are now possible. The outings include trips to Southend, rugby at Twickenham, and an Easter church service. People sign if the wish to take part in one of these outings, and a draw is then made of the names to ensure fairness. Four people take part in a weekly drama workshop at Community Focus in Finchley, and on the day of our visit they were preparing for a performance there. One person had moved to New Court Place for assessment and support for daily living skills before moving to their own flat. The home will arrange for the care worker who will provide live in care in the community to come to the home to shadow and learn the persons needs. The people who spoke to the expert by experience (EBE) said that they could not go out to local shops or to the pictures due to staffing levels and key workers not having enough time to take them. They said that they never go out in the evenings or do anything spontaneous. This should improve when the new activities co-ordinator completes their induction. The AQAA recognised the difficulties in supporting everyone as they would wish. Each Resident is encouraged to pursue personal interests but due to their individual disabilities this almost always requires high support input. And in the care reviews we discuss the level of support the individual will require to achieve their wishes and then the care manager with the individual will decide what is financially feasible. However the atmosphere that we observed in the home was that people were engaged and involved in social activities, and the staff spent time talking to and supporting people as they wished. The people who completed surveys all said that they can do what they want to during the day and at evenings and weekends. One person said that what the home could do better is to, Employ some more staff to do activities and outings at weekends. Another person commented,The home has good parties. Get our families involved. Good at getting residents to mix. The people who we spoke to told us that they visit their families, and their families can visit them. One person who we spoke to was very excited, because they were going home with their parents for Easter weekend. Meals are served in a cafeteria style area with adjustable seating and table heights to accommodate a range of needs and equipment. The AQAA stated, Each resident is consulted prior to their meal as to what they would like to eat and following discussions with the residents a core menu for evening meals has also been added to the main meal. We have a 3 week menu where we aim to have something different on Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: each day. The menus are used as a guide to support healthy options and residents are fully aware that if they do not like the specific option on a set day they are able to select a similar meal in consultation with the cooks. We confirmed this during the inspection. The cook told us that people can request an alternative to the menu at any time, and she can always, knock up a quick sandwich or omelette. There is a kitchenette in each residents room, and they are able to make their own drinks and snacks if they wish to. There is a hot drinks machine and a water cooler at wheelchair height in the dining room. Everyone in the home requires staff support to eat their meals. The AQAA stated that some residents will have to negotiate a time for their meal and assistance. We observed lunch. It was a social occasion, and the staff supported people to eat as they wished and at their own pace. Care Homes for Adults (18-65 years) Page 17 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is proactive in addressing any possible health needs. There is an experienced and enthusiastic team of staff who have the training and skills to provide a good quality of care for the people who live in the home, and to ensure that their individual needs, choices and preferences are met at all times. Evidence: The home provides a good quality of personal care and health care. There is good relationship between the staff and the people who live in the home. Everyone needs two people to help them with their personal care. The staff are aware of each persons individual needs and preferences, and they support them to make appropriate choices and decisions about their lives in the home. The residents have a preferred plan of care, which sets out how they wish to receive their personal care. The people who we spoke to said that the staff support and help them as they wish, and treat them with respect. We observed a good relationship between the care staff and the residents. The staff take time to communicate with people, using equipment if needed, and we saw good practice in assisting people to eat and drink. The people who spoke to the expert by experience (EBE) said that that staff do speak to them, but some felt that they were told off a lot and spoken down to and that were told to have manners when Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: they were given something or spoken to. The manager and head of care were aware of this and are addressing it with some members of staff. Everyone who completed a survey said that the care staff and managers treat them well. Comments in the surveys include, Cares for me very well. And, They do well in all aspect of care. The care plans provide appropriate details of each persons health needs, including pressure care concerns and monitoring of epilepsy. When we visited the home last year we spoke to a visiting GP, who said that the home provides very good healthcare for the people who live there, and the staff work well with visiting professionals. We have since then received a letter from the GP confirming this good practice. The manager told us that a lot of conditions improve because the nurses recognise and intervene before an illness becomes serious. Because of this there have only been two emergency hospital admissions in past 12 months. The Annual Quality Assurance Assessment (AQAA) stated, As we liaise with the individuals they are able to take part in deciding the care they require therefore this assists in the treatment plans being successful. As we actively support the residents should they require hospital admissions, we are aware of the limitations of the care provision within the hospital setting and actively seek to assist the resident to return to their home as soon as possible to support their quicker recovery. The Commissions pharmacist inspector visited the home in November 2009, to assess progress towards meeting some of the requirements made at the last key inspection. He found that the majority of medication was stored securely for the protection of residents. In general the records made when medicines were received into the home, when they were disposed of and when medicines were given to people were in good order, accounted for medication in use and demonstrated that people receive their medicines as prescribed. The home carried out regular checks on the accuracy of medication records and the pharmacist inspector commended this as good practice. On this occasion we made a spot check of the medication records for two people. We found no errors or areas of concern. The AQAA stated, We have reviewed the records of all medication administered by the unit in conjunction with the GP to ensure that there is a clear audit trail for the management of medication. We have changed the pharmacy who supply the medication for our residents which has seen an improvement in the dispensing packaging and made it easier to use. The nursing staff liaise with the pharmacist frequently to support the medication requirements of the unit. The home has a robust system of regular medication audits that include reconciliation of stocks and administration records, and concentrate on where problems have been in the past. Care Homes for Adults (18-65 years) Page 19 of 30 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. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. Evidence: The home has a clearly written complaints procedure. The Annual Quality Assurance Assessment (AQAA) stated that two complaints have been recorded since the last inspection, and both were resolved. The residents are continually encouraged to discuss any concern they have with any aspect of their care and advised that they are able to discuss these with any person they feel comfortable with. The majority of residents will come to someone if they are not happy about something and staff if they are approached are asked to ask the individual what they would like to happen next, they are asked also would they like this to be passed to the unit manager and whether they wish to formalise the concern as a complaint and are reminded of their rights to do this and what the process is. The residents who we spoke to confirmed that they are able to discuss any concerns that they have, and that these are addressed. All the people who completed surveys said that they know who to speak to if they are unhappy, and most of the people who spoke to the expert by experience (EBE) said that they know how to make a complaint. Livability has robust policies for dealing with allegations of abuse or neglect. All the staff have training in safeguarding vulnerable people, and those who we spoke to were aware of the whistle blowing policy and who to speak to if they have any concerns. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: The manager is aware of the principles of the Mental Capacity Act and the Deprivation of Liberty Standards (DOLS), which protect people from restraints that may be in place without proper authorisation. No-one living in the home is currently subject to a deprivation of liberty authorisation, and no-one currently has their liberty deprived without an authorisation. Care Homes for Adults (18-65 years) Page 21 of 30 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. The home provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. Evidence: New Court Place was purpose built as a care home for people with physical disabilities. The rooms are designed as studio style flats, each with a bedsitting room, a kitchenette and an en suite shower room with WC. Many of the fittings can be adjusted to suit individual needs. Each person has equipment that suits their needs, including hoists and environmental aids. The rooms reflect individual tastes and interests. The doors to the residents rooms lead off wide corridors that are planned to resemble streets. Wide doors, corridors and lifts mean that people who have to spend some time in bed can still access the communal areas. All areas of the home are wheelchair accessible. The large recreation and dining area on the ground floor is a sociable space, and the cafeteria style dining area enables people to have access to drinks and snacks. The home appeared to be clean and well maintained and appropriate policies and procedures are in place for the maintenance of hygiene and control of infection. The Annual Quality Assurance Assessment (AQAA) stated, There are clear instructions on managing the hygiene within the unit and the fact that no resident has acquired any Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: infection whilst living at the home demonstrates that the cleaning schedules are working. One resident who returned from hospital with an acquired infection was managed with the infection being contained within the unit to just the individual, demonstrating that infection control procedures are working. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. Evidence: The people who live in the home are supported by a stable team of nurses and care workers. Livability completed a staffing review and implemented changes in May 2009. This resulted in a slight reduction in the number of registered nurses (RGNs). The staff rotas show that one registered nurse and seven care assistants work in the morning with one registered nurse and six care assistants in the afternoon. One registered nurse and three care assistants work at night. Most shifts include part time bank staff. The head of care provides some nursing cover so that the RGNs can carry out supervisions with the care workers. We looked at the staff files for two members of staff who have been employed since the last inspection. They both contained all the required information to show that the home practices a robust recruitment procedure that ensures the person is fit to work with and protect the vulnerable people in the home. The Annual Quality Assurance Assessment (AQAA) stated that 12 of the care staff, 70 , have a qualification in care at NVQ level 2 or above. The Head of Care and the Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Unit Manager have started their Leadership and Management programme. NVQ qualifications are also available for the housekeeping staff, activities staff and kitchen staff. Training is organised by Livability training department, and everyone has regular updates of the mandatory health and safety training. The staff who we spoke to said that the have a lot of training. Additional information sessions are provided in the home by professionals such as the Speech and Language Therapist and the Community Learning Disability Team. These are usually arranged to provide information on a persons specific needs. The staff who we spoke to said that they are supported by the managers and the organisation. There are regular staff meetings, and the supervision records show that everyone has regular one to one supervision. The staff who completed surveys gave generally positive responses. Four of the nine surveys showed some concerns, but most were concerns for only one person. Three people said that there are only sometimes enough staff to meet the individual needs of all the people who use the service. One person commented, Theres a need for more carers per shift in order to give the high quality care required by the service users. However the same person also said, The home is good at encouraging independence in the service users. The carers have regular training in moving and handling, health and safety and are well equipped with the latest equipment, for example hoists. Other people commented, Manager and staff work very hard as a team so we could give the best support for the residents and look after them well. And, The home is very good at meeting the needs of all residents. It caters well to everyone, and responds well to any issues. There is great teamwork within the staff, and good communication. The staff who we spoke to during our visit also spoke of good teamwork among all the staff, from managers and nurses to domestics and administration. We accept that there may always be a wish for more staff in order to provide a better quality of care, but we saw no evidence that there was a lack of staff that affected the quality of life of the people who live in the home. This may be summarised by another comment form a staff survey: With more money NCP could exceed its already high standards. Care Homes for Adults (18-65 years) Page 25 of 30 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. The home is well managed, and the management team actively seeks the views of the people who use the service and other involved people in order to ensure that a good quality of care is provided. Evidence: The manager is a qualified nurse. She previously worked at the Chalfont Centre for Epilepsy, and she is a qualified trainer for first aid, infection control and management of epilepsy. The manager and the Head of Care have started the Leadership and Management qualification programme. The management style is to value and support the staff, and to be available to the people who live in the home. The manager completed the Annual Quality Assurance Assessment (AQAA) with all the information that we requested. It showed understanding of the importance of promoting equality and diversity in the service, and an honest awareness of areas where the service hopes to improve. The ethos of the home is to provide a person centred service for the people who live in the home. The staff see their role as supporting people to take decisions about their Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: lives in the home, and to be as independent as possible. The manager described the ethos of the home as providing support to people with minimum interference to their daily lives. staff are aware that they are guests in the home of the residents. The responses to surveys from residents and staff, the information in care plans, observation of the staff and residents, and discussions with staff and residents, all confirmed that everyone is encouraged to make their views and wishes known. The Annual Quality Assurance Assessment (AQAA) stated that Livability is undertaking a full audit of the services provided seeking the views of residents, staff, visitors and professionals. The residents are taking part in gathering some of the data. The data will be audited independently from the unit and will be collated into a report for individuals to read. The last report was produced in November 2008, and we saw this during our last key inspection. The proprietor organises regular monitoring visits to the home, and these are usually carried out by the manager of another Livability home. We saw the report of the last monitoring visit in February 2010, which included the views of people who live in the home. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the homes policies and procedures. All staff have training in health and safety that includes moving and handling, prevention and control of infection, and fire safety. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!