Care Home: Newlands

What the care home does well People were thoroughly assessed and met the criteria of being responsive to rehabilitation before being offered a placement. People were involved in extensive, individualised rehabilitation programmes. People`s support plans were clear, comprehensive and well written. People and their supporters were fully involved in setting their individual goals. People had regular access to a wide range of therapists in order to support them with their individual programme of rehabilitation. A range of up to date, well written risk assessments were in place. There were clear, organised systems in place to manage people`s medicines. A structured self medication programme enabled people to safely manage their own medicines, as required. People were clear about how they should raise a concern or make a formal complaint. Staff were very clear about their responsibilities in safeguarding people from abuse. The staff were committed to enabling people to reach their full potential and to move on to more independent living, when they were ready. Organised health and safety systems were in place, to safeguard people from harm. Specialist services were used to gain expertise in certain areas such as fire safety, in order to maximise people`s safety. The overall management and administrative systems of the service were very well organised. What has improved since the last inspection? There were clear care plans in place regarding what triggered the administration of a person`s `as required` medicine. A new day centre had been opened on site for therapy groups, one-to-one sessions and leisure activities. New lounge furniture and a microwave had been purchased. The `old` smoking room had been refurbished to accommodate a therapy room, a gym and an area for people to undertake their own laundry. A smoking shelter had been erected outside to enable people to smoke outside in the dry.A policy and procedure regarding any equipment shared across the site had been devised. Plans were in place to fully refurbish the organisation`s central laundry facilities. The safe systems of managing people`s personal monies formed part of the staff induction programme. What the care home could do better: When staff document, `please observe` within people`s daily records, further entries should follow to show that the instruction has been adhered to. When making a record of a mark or bruise identified on a person, specific information such as it size and colour should be stated. Consideration should be given to supporting people to cook all of their meals rather than relying on the meal delivery from the main kitchen. Continence aids should be stored more discreetly. Consideration should be given to the refurbishment of the shower room. The main laundry requires a thorough clean with particular attention given to the surrounding areas of the washing machines. Additional storage should be considered in the laundry room so that items are not left on the floor whilst awaiting a `second` wash. A risk assessment should be undertaken in relation to staff carrying laundry from the laundry area, to the ironing and storage area upstairs. A review of staff training should take place so it is identified what training staff need, in order to update their learning and development. Those staff members who take the responsibility of running a shift, should receive management and leadership training to ensure they have the skills to manage effectively. One to one formal supervision with staff should be formalized further. It should be consistently undertaken at the recommended frequency, be ongoing and contain measurable targets, which are reviewed at the next session. Environmental risk assessments, which were originally devised in 2005, should be rewritten when next reviewed. Key inspection report Care homes for adults (18-65 years) Name: Address: Newlands Newlands South Newton Salisbury Wiltshire SP2 0QD     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: Alison Duffy     Date: 0 3 0 2 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 40 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 40 Information about the care home Name of care home: Address: Newlands Newlands South Newton Salisbury Wiltshire SP2 0QD 01722742066 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): newlands@glensidemanor.co.uk Glenside Manor Healthcare Services Ltd Name of registered manager (if applicable) Mrs Amanda Jane Miller Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Newlands is a 9 bedded rehabilitation unit for younger people with acquired brain injury. Newlands is not the persons permanent home as, on completion of their rehabilitation programme, they will move onto a permanent placement, which suits their individual needs. Newlands is part of a group of services, all on one campus owned by Glenside Manor Health Care Services Ltd. Mr Andrew Norman is the nominated responsible individual. He is supported by a senior management team. Ms Sam Broadhurst is the acting manager of the service. Ms Broadhurst is currently in the process of registering with us to become the registered manager. Care Homes for Adults (18-65 years) Page 4 of 40 9 Over 65 0 Brief description of the care home In addition to the care staff team, a team of therapeutic staff, including medical staff, physiotherapists, occupational therapists and psychologists are employed to work across the Glenside group. One catering and laundry department supplies all the different services within the complex. A maintenance team also works across the site. People have a single bedroom on the ground and first floor. A range of different recreational and therapeutic space is provided on the ground floor. The group of services is situated in the village of South Newton, on the A36, five miles north west of the city of Salisbury. A main line train station is in Salisbury, the A 36 is on a bus route and ample car parking space is available on site. The home has a service users guide, which is offered to all prospective people and/or their supporters. Care Homes for Adults (18-65 years) Page 5 of 40 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: Before visiting Newlands, we sent the service an Annual Quality Assurance Assessment (AQAA) to complete. The AQAA is the services own assessment of how they are performing. The AQAA tells us about what has happened during the last year and about the services plans for the future. We sent surveys, for people to complete if they wanted to. We also sent the service surveys to be distributed to staff and health/social care professionals. This enabled us to get peoples views about their experiences of the service. We received surveys back from seven people using the service. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home. This visit took place on the 29th January 2010 and 3rd February 2010. Ms Broadhurst was on annual leave on our first visit but came in to the service Care Homes for Adults (18-65 years) Page 6 of 40 to assist as required. She was available throughout our second visit. Ms Broadhurst and Mr Norman, Responsible Individual, received feedback at the end of our visit. During our visit, we toured the accommodation and met with people who use the service. We spoke to staff members on duty and observed how they interacted with people. We saw people having lunch. We looked at care-planning information, staff training records and recruitment documentation. We also looked at documentation in relation to health and safety and complaints. The last key inspection of this service took place on 13th March 2007. All key standards were assessed on this inspection. Observation, discussions and viewing of documentation gave evidence, which showed whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. Care Homes for Adults (18-65 years) Page 7 of 40 What the care home does well: What has improved since the last inspection? There were clear care plans in place regarding what triggered the administration of a persons as required medicine. A new day centre had been opened on site for therapy groups, one-to-one sessions and leisure activities. New lounge furniture and a microwave had been purchased. The old smoking room had been refurbished to accommodate a therapy room, a gym and an area for people to undertake their own laundry. A smoking shelter had been erected outside to enable people to smoke outside in the dry. Care Homes for Adults (18-65 years) Page 8 of 40 A policy and procedure regarding any equipment shared across the site had been devised. Plans were in place to fully refurbish the organisations central laundry facilities. The safe systems of managing peoples personal monies formed part of the staff induction programme. 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. Care Homes for Adults (18-65 years) Page 9 of 40 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 10 of 40 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 11 of 40 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. People benefit from a full and detailed assessment of their needs from the multidisciplinary team prior to their admission. Evidence: A staff member told us that there had not been any changes to the admission processes since the last inspection. They said that when a referral for admission was made, a member of Glensides management team and a therapist met with the person. During this time, an assessment was undertaken. If it was felt the persons needs could be met within the campus, further assessments would be completed. At this time, the manager for the service where the person would be placed would be involved in the assessment process. Staff told us that the person needed to meet the criteria of being able to benefit from a rehabilitation programme. As well as gaining information from the individual about their needs, information would be sought from important others such as family Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: members and involved health and social care professionals. The person and their family would be encouraged to visit the service before making a decision to accept the placement offered. The AQAA confirmed this by stating all Potential Service Users are given a brochure which is currently being updated to be more Service User friendly (large print including more symbols and pictures.) Potential Service Users and relatives are invited to visit the home and meet with unit Staff and Therapists prior to admission. We saw within the AQAA that a new goal planning format was to be devised in order for peoples aspirations to be in place prior to admission. In relation to equality and diversity, the AQAA stated Pre-admission assessments to allow time to prepare for any special requirements/equipment required to meet the individual needs of the Service Users. Good Care planning. We looked at the admission process of one newly admitted person. A detailed admission checklist was in place. We saw that the assessment undertaken was ordered, comprehensive and well written. Documentation not only identified the persons needs, it also identified the persons life before their brain injury. There was information from the persons consultant and specialist nurse. Confirmation of the service being able to meet the persons needs was in place. We saw that the assessment process was specifically related to peoples rehabilitation programmes. Within surveys, people told us that they were asked if they wanted to move to the service, before doing so. Five people told us that they had enough information so they could choose if it was the right place for them. Two people told us that they did not receive enough information. Care Homes for Adults (18-65 years) Page 13 of 40 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. People benefit a comprehensive rehabilitation programme which has been devised by the goals they have set with a multi-disciplinary team. People are supported to make increasingly independent decisions about how they want to lead their lives. People are supported to take risks as part of an independent lifestyle. Evidence: Within surveys, in relation to what the service did well, one person said Newlands has given me and my [partner] hope and the confidence to live our lives as normal as possible in the future. Newlands and the staff have totally changed my life around, all for the better. Another person said rehab. Giving a chance to have a second chance. Other comments in relation to what the service did well were creating a homely environment, everything, they care for you and they look after me well. One person told us that they were totally satisfied with the service they received. They said theyre getting me back on track. Theyre all very good. Im where I need to be. Another person said theyve helped me but now I need to move on. Within Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: discussion, staff showed commitment and a focus for enabling people to achieve independence and reach their potential. Staff said that developing peoples abilities to make decisions about their lives again through re learning skills was centre to their role. Seeing people as individuals and enabling people maximum opportunity were seen as essential factors for the persons success. Staff told us that people were supported by a multi therapeutic team to set goals in terms of their own rehabilitation. Other important others such as family members were also able to contribute to the process. Once a framework of the persons initial goals had been established, a rehabilitation support plan was developed. This was undertaken with the person and they signed to show their involvement, ownership and agreement. We looked at three rehabilitation support plans in detail. All were very detailed, comprehensive and well written. The plans were easy to read and were regularly reviewed. The plans were written by different members of the multi therapeutic team, depending on the area of need. All clearly showed the support the person needed in order to achieve their goals. We saw that the plans contained information about peoples daily living skills and developing communication and social skills. Within one plan we saw that staff were encouraged to think outside the box and be creative in the support offered. For example, the use of pictures or drawings was identified, as a means to assist the person with their communication skills. Within the plans, we saw that there was clear information about maintaining the persons human rights and enabling them to be involved in the political process. There was information about the rationale for restrictions and limits to personal freedom. Within one rehabilitation support plan the persons nutritional needs and their gradual weight loss were identified. We saw that the person repeatedly left the table during their lunchtime meal. Staff told us that this was a usual pattern of behaviour yet the person usually ate what they wanted through repeated attempts. We advised that the process of monitoring food intake be detailed within the persons plan. The person was regularly weighed and their body mass index calculated. The records showed that despite control measures being in place to promote weight gain, the measures were not fully successful. We recommended that this be addressed within the evaluation of the plan. People had their own individual weekly timetable of activity, which they agreed to. The timetable was specifically related to their overall rehabilitation programme. We saw that some programmes were in pictorial formats to make it easier for people to read and understand. There were also written formats of peoples daily routines. Staff told Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: us that people were encouraged to be involved in daily housekeeping tasks such as clearing away the dishes, washing up and doing their own laundry. Their level of involvement was dependent on the person, their wishes and the level of their skill and ability. A range of comprehensive risk assessments formed part of each persons rehabilitation programme. The assessments clearly supported people with regaining skills as part of an independent lifestyle whilst maintaining wellbeing. We saw that all assessments were detailed and up to date. Many of the assessments were undertaken by the multi therapeutic team and showed step by step control measures to minimize potential risk. There was good use of photographs for the safe use of equipment. We saw that in addition to the overall assessment, there was instruction for staff to undertake their own risk assessment before proceeding with any task. Staff maintained daily records of the persons activity and general well being. We saw that these were detailed, clearly written and non judgemental in style. Within one record we saw that one person had choked on a large piece of food. Staff told us that the person often ate quickly so this was an additional risk. We advised that this be addressed within the risk assessment process. We saw within the AQAA, that over the last twelve months care review reports have improved to show a multi disciplinary approach to Service Users care. In relation to what the service did well, the AQAA stated we involve Service users in decisions regarding their health care needs, key workers, individual rehabilitation programmes and leisure activities. Care Homes for Adults (18-65 years) Page 16 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in a range of activities related to their needs yet greater opportunities could be available to those people, not actively responding to a rehabilitation programme. People are supported as part of their rehabilitation programmes in how to use community resources. Peoples rights and responsibilities as individuals are respected. People are offered a healthy diet yet their independence could be further promoted through more involvement in meal preparation. Evidence: As Newlands is a rehabilitation unit for people following brain injury, the whole ethos of the service relates to re-establishing each persons skills. This means that during the working week, each person has a programme of therapeutic activities which they have agreed to be involved in. As with usual working life, leisure time is largely in the evenings and at weekends. Some people go back to their own homes at weekends. Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: In relation to what the service did well, the AQAA stated encourage and support Service Users to access the community both socially and as part of their rehab programmes. Social activities on the unit e.g. Theme nights including a takeaway meal and a video relevant to the theme. We support Service Users to spend weekends at home with their Families by carrying out access assessments and providing written guidelines on how to support their needs. As Newlands is not the persons permanent residence, involvement in the local community relates to their individual needs and aims for rehabilitation. Staff talked in detail about peoples rehabilitation programmes or activities for those who had been identified as not responding positively to rehabilitation. Staff were very aware of peoples needs and the goals which were being worked towards. People told us about individualized activities that they were involved in. This included going into town for shopping and a coffee or going to the local pub either alone or with staff or peer support. One person told us that they had a public transport pass so they could go out and about when they wanted to. They said they often used the cafe on site. They said there was a Gym and Hydrotherapy pool on site which could be used for therapeutic purposes and/or for leisure. During our visit, we saw that one person was supported to go out and another person went out on their own. Another person was supported to go to the dentist. Other people were involved in rehabilitation sessions with various therapists. One person spent large amounts of time in their room. We saw that they often came out of their room to see staff and perhaps ask a question, but quickly returned. Staff told us that this was the persons usual daily routine. While acknowledging that this was so, we said that ways of engaging further with the person should be considered. The manager told us that the persons support had been reviewed in order to establish better ways of meeting the persons needs. Within surveys, two people told us they could always make decisions about what they wanted to do each day. Four people said they could usually make decisions. One person said they sometimes could. Three people told us that they did what they wanted to during the day. Three people said they could not. One person said they could not do what they wanted to do during the evenings or at weekends. One person said provide interest was something the service could do better. A therapist told us that staff were excellent at meeting peoples health and social needs. They said that staff looked at people holistically and thought about the impact of activity on wellbeing. They told us of a situation whereby at the last minute, a person wanted a birthday card and a present for their friend. They said that staff Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: worked hard to accommodate the persons request and they were supported to go into town, to get what they needed. Offering more activities both on site and in the community during the evenings and weekends was something the AQAA stated the service could do better. Over the last twelve months, we saw that vocational opportunities had been developed on site. This included the Bee keepers project and work placements in the on site coffee shop. The AQAA stated that the Horizon day centre had been opened during the day for therapy groups and one-to-one sessions. The centre was also used in the evening and at weekends for leisure activities. This included watching television, playing on the Wii games console or spending time in the computer room with Internet access. The AQAA confirmed that over the next twelve months, developing social activities and encouraging inter unit interactions was planned. This was expected to increase the opportunity for people to socialise with others. In relation to equality and diversity, the AQAA stated spiritual needs are timetabled into Service Users day if required. We have supported individual Service Users to celebrate religious festivals i.e. Chinese New Year. We support Service Users to gain access to their individual places of worship. Good Care planning. New Menus to incorporate choices for cultural preferences. We saw that the service was to appoint a religious beliefs key person to support people in meeting their spiritual needs. As people were undergoing rehabilitation following a brain injury, family members and friends were regarded as very important in their rehabilitation programme. Significant relatives were often closely involved with therapists and staff in goal setting. People went out for extended periods away from the service with their families as part of their rehabilitation programme, if this suited their needs. As identified at the last inspection, psychologists were closely involved in developing rehabilitation programmes whereby people were supported in re-gaining appropriate social skills to support them in their existing relationships as well as with developing future relationships. Within the AQAA we saw that healthy diets are encouraged and special dietary requirements met and encouraged. Staff told us that people did not have any specific dietary preferences or requirements at this time. They said that specialist advice, for example from a dietician or speech and language therapist, would be sought, as required. One person told us that they prepared their own breakfast. They were offered a sandwich bar at teatime so they could prepare their own sandwiches or snacks. Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: Another person told us that they were planning to plan their own menu and then shop for the ingredients. They said they were looking forward to preparing and cooking their own meals. We saw that at lunch time, the meal was delivered in a heated trolley from the central kitchen. We saw that staff monitored the foods temperature before it was served. Staff told us that the food was generally well cooked and people had a good range of food to choose from. We saw that one person had chosen a salad instead of the main meal. This looked colourful and was attractively served. Another person had cheese and biscuits instead of a pudding. Staff told us that people could change their mind even though they had ordered a specific meal. They could also have an alternative snack such as something on toast or cheese and biscuits. We saw that people were able to help themselves to fresh fruit. Staff told us that healthy eating was promoted yet takeaways were also ordered. One person told us that they did not like the meals. Due to this, they said that staff had agreed for them to cook their own meals and become more independent. Another person told us that the food was alright. Within surveys, two people commented that the food could be better. One person said have more food and drinks. As a means to improve the service, we recommended that consideration be given to supporting people with food preparation in the kitchen rather than relaying on the use of the lunch time meal trolley. Care Homes for Adults (18-65 years) Page 20 of 40 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. People receive the personal support that they need, in accordance with their written rehabilitation programme. People benefit from excellent intervention from multi agency professionals enabling their health care needs to be met. Clear, ordered systems are in place to safely support people with managing their medicines. Evidence: In relation to what the service did well, the AQAA stated key worker and associate worker system in place. Service users are fully involved in the identifying suitable people/person to take on the role. Self medication pathway used to enable Service Users to become more independent. Care plans for Participating in healthcare decisions. Service Users supported to access the G.P surgery rather than being visited on the unit as part of their rehab programme. Service Users encouraged to attend their own reviews and to chair them where possible. The AQAA continued to state Service Users are much more involved in care planning by assessing for capacity and consent with each care plan that is written. We saw that much of the ethos of Newlands was about helping people to re-learn self care skills. The support people needed to do this was clearly identified within their Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: rehabilitation programme. Within one programme, we saw that an occupational therapist was working with a person to develop their skills in standing and dressing independently. A therapist told us that they felt the staff team were excellent at following the rehabilitation programmes in place. They said all staff had a very good attitude to rehabilitation and had the skills to promote achievement rather than doing things for people. The therapist told us that staff were very good at informing them of what was working or what the person was finding difficult. They said this enabled them to talk to the person about it and make adjustments to the programme, as required. The therapist told us that staff followed instructions and showed good teamwork. They said the enablement support which took place over the twenty four hour period was integral to the success of the placement. They said without this, their work as therapists was non productive. One staff member told us that the staff team worked closely with the therapists and good relationships had been developed. They said they could openly discuss peoples progress and any resistance the person might have to certain aspects of their programme. Within documentation we saw that people were regularly monitored and re-assessed by the range of therapists on site. This included physiotherapists, occupational therapists, speech and language therapists and psychologists. We saw that people were also regularly monitored by local GPs and attended specialist appointments with consultants as required. Staff told us that people attended the GP surgeries for appointments. A GP also visited the service on a planned weekly basis in order to give advice, monitor peoples health care and deal with more immediate issues. Staff told us that this system worked well. The AQAA confirmed that there was an on site hairdresser and podiatry clinic, which people could attend on an appointment basis. We saw that people had been regularly assessed in terms of their nutrition and their risk of developing a pressure sore. People were regularly weighed and their body mass index monitored. There were also manual handling assessments in place. We saw that all assessments were very detailed, comprehensive and well written. All were up to date through regular, on going reviews. As stated earlier in this report, staff maintained daily records of peoples general health and well being. Within one record we saw that a person had become very restless and agitated. The staff member had recorded please observe yet no further entries had been made. We saw that body charts were used to document any Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: unidentified marks or bruises on a person. One chart showed a circled area yet there was no description to explain the type of mark, its size or its colour. We advised that specific information be recorded on the body maps so that the healing process could be clearly monitored. As part of rehabilitation programmes, people were enabled to self medicate, as they became ready to do so. There was an agreed protocol in place for self-medication. This used a four-staged approach, so that people moved to gradual increased independence with their medication, as they became more able to do so. All Service Users to be on the Self Medication pathway as part of their rehab programme was something the service said they could do better. A staff member told us that only senior staff had access to and were able to administer medicines. If a person needed as required medicine, for example at night when there were no senior staff on duty, staff contacted a registered nurse from another service. The staff member said that this rarely happened. They told us that all staff undertook safe handling of medicines training and a competency assessment before administering peoples medicines. We saw that all medicines were stored securely. Staff carried the keys of the medicines cabinet with them at all times. Staff told us that since the last inspection, the medicines supplier had been changed. There were full records of medicines received into the home and of those returned to the pharmacy. Staff had signed the medicine administration record to show they had administered peoples medicines. At the last inspection, we identified that care plans needed to be in place for all people who were prescribed as required medication. Staff showed us that these were now in place. The information was clear and directed staff on when to give the medicine. There were regular evaluations, so that the effectiveness of treatment programmes could be assessed. When people went away for a weekend, their medicines were given to their supporters in accordance with the services policies and procedures for periods of leave. We saw that full records were maintained. Staff told us that homely remedies were given as required for a maximum of 48 hours. We saw that a GP had signed to authorise the medicines, which could be given as homely remedies. At the last inspection, we recommended that stocks of medical dressings were regularly reviewed so that items did not exceed their expiry date. There was no evidence of any items which were out of date during this inspection. Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: There had been one recent medication error. This was reported to us under regulation 37. We spoke to Ms Broadhurst about this and she explained the circumstances. While acknowledging that the person was not harmed from the error, the error should not have occurred. Ms Broadhurst told us that the incident had been a clear learning point for the staff team. Additional safeguards had been put in place to minimise further occurrences. Care Homes for Adults (18-65 years) Page 24 of 40 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. People are aware of how to raise a concern or make a formal complaint. People are protected through well managed adult protection systems. Evidence: In relation to what the service did well, the AQAA stated complaints policies and procedures in place. Open Door Policy for Service Users and Relatives to encourage them to feel that they can discuss any concerns or complaints. Displayed information on how to use the complaints procedure on the public notice board and in the Service Users guide. People told us that they would tell a member of staff if they were unhappy about a situation. One person said I would talk to my keyworker about anything that wasnt right. It would soon be sorted. Within surveys, six people told us that they knew who to speak to if they were not happy. One person told us that they did not know who to speak to. Six people told us that they knew how to make a formal complaint. One person said they did not know how to do this. Staff were clearly aware of how to respond to a concern or complaint. One staff member told us that they would aim to resolve the situation immediately. They said if Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: this could not be done, they would inform a manager, in order for the issue to be taken further. The staff member told us that if the complaint was about the manager or management issues, they would go directly to a senior manager. They said they would also give the person, the opportunity to raise the concerns with management themselves. We saw that copies of the complaint procedure were readily available in the entrance area of the service. We looked at the complaint log and saw that there had been two formal complaints since the last inspection. These had been addressed within the identified timescales. We saw that peoples vulnerability as an individual and the process to follow if an allegation was made, were identified on peoples support plans. Staff told us confidently about what they would do in the event of a suspicion or allegation of abuse. We saw that the local safeguarding reporting procedures No Secrets were displayed on the notice board in the office. There was also information about Deprivation of Liberty Safeguards. As detailed within the AQAA, staff told us that safeguarding training for staff was an annual event. The training records however did not demonstrate this for all staff. We saw that additional training for staff on capacity and consent, Best Interests and Deprivation of Liberty was planned. At the last inspection, we noted that there were clear policies and procedures in place regarding the management of peoples personal monies. The systems in place were also well managed. We saw that an audit of finances was completed on a regular basis, as part of a senior managers regulation 26 visit. Due to this we did not look at the arrangements for the management of peoples personal monies during this visit. We previously recommended that responsibilities for handling peoples personal monies be included in staff job descriptions. We also recommended that the area, including legal responsibilities, be included in induction and training programmes. Ms Broadhurst told us that she was not aware if staff job descriptions had been updated. She said that the topic was included in the staff induction programme. Care Homes for Adults (18-65 years) Page 26 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a clean, homely, well maintained environment. There are significant shortfalls within the central laundry facilities yet due to people undertaking the majority of their own laundry, the impact of this on individuals, is minimal. Evidence: The AQAA stated we provide a safe and homely environment. Service Users are supported to participate in household tasks as if they were living in their own home as part of their individual therapy programme. People had a single bedroom which they could personalise as they wished. Bedrooms were located on both the ground and first floors. A passenger lift was available to enable people easier access to all areas. People had a key to their bedroom. Staff told us that they respected peoples bedrooms as the individuals private space. There were a range of communal rooms on the ground floor. This included a lounge, a large therapy/activities room, a kitchen and a dining room. The old smoking room had been turned in to a gym and therapy room with an area where people could do their own laundry. A smoking shelter had been installed in the garden so that people could smoke outside in the dry. We saw that the gardens had full wheelchair access and were well maintained. Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: Staff told us that there had been no real changes to the environment other than the development of the laundry, gym and therapy area. They said there had been new settees in the lounge. The AQAA stated that refurbishment and redecoration were things the service could do better. New furnishings and decoration were planned for the following twelve months. We saw that the service was cleaned to a good standard. However, the shower room was showing its age and the tiling was discoloured. We said that the room would benefit from refurbishment. Ms Broadhurst told us that there were plans for this. She said it was anticipated that the room would be totally refurbished and turned into a wet room. Within the bathrooms and toilets we saw that the storage of continence aids was visible. We advised that they be stored more discreetly. At the last inspection we made a requirement that the microwave be replaced. Staff told us that this had been undertaken. We also made a requirement that a policy and procedure regarding equipment that was shared across the site, was put in place. We saw that this had been completed. There was a central laundry, which supported all services on site. Staff told us that only non personalised items were sent to the laundry from Newlands. People were supported to manage their individual laundry themselves. At the last inspection we noted that there was a high level of dust and debris between the washing machines. We made a requirement to address this. We saw that the laundry area within the service was very clean. However, the main laundry was not. There were high levels of dust and debris around the machines and cobwebs on the wall and at ceiling height. A staff member told us that they had tried to find equipment, which could clean between the limited spaces around the machines. However, this had proved unsuccessful. We saw that the layout of the main laundry did not promote advised infection control guidance. Clean laundry was carried through areas of soiled linen. Staff then carried the laundry upstairs to the ironing/storage areas. The stairs used were very steep and appeared hazardous for staff. We said that risk assessments were needed to minimise the risk of potential accidents. We saw that the ventilation in the room was very poor. One of the washing machines was out order. Staff told us that this had caused disruption to the service as it had not been working for a few days. Some laundry that had remained stained after being washed was put on the floor. This practice needed review. Staff told us that the items would be rewashed when all other laundry had been completed. They said that limited space caused difficulties in this area. Staff were clear about the procedures in place for managing soiled linen and transporting Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: laundry to and from the services. Mr Norman told that he was aware that the requirement we made previously about the laundry had not been met. He said that the whole area was to be replaced with new state of the art facilities. Mr Norman told us that the plans for the new laundry had been drawn up and the work would commence shortly. Mr Norman told us that the plans had been shown to us during a previous inspection of another service. Within surveys, six people told us the service was always fresh and clean. One person said it usually was. Care Homes for Adults (18-65 years) Page 29 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from the support of a committed staff team. People were protected by a robust recruitment procedure. Staff training and supervision needed to be given renewed focus to ensure that each staff member was fully up to date with their knowledge and skills. Evidence: A member of staff told us that there were generally four or five staff on duty during the morning and four staff on duty during the evening. This included a team leader. The service was also supported by the complexs central staff services. This included maintenance, catering, laundry and therapy staff, as well as site management, administration and a personnel department. At night, there were two waking night staff. The staff member said that additional on call support could be gained from the registered nurses on duty within the other units, if required. There was also an on call management system in place. Two staff members told us that they believed staffing levels to be sufficient to meet peoples individual needs. While acknowledging that the service was not operating at full occupancy, we saw that people received varying one to one time with staff. One staff member told us that staffing levels adequately enabled people to be supported to go out, as part of their rehabilitation programme. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: People confirmed that they were happy with the support they received from staff. One person said the support we get is invaluable. The person told us about the positive relationship they had with their key worker. People told us that staff were available when they needed them. Within surveys, six people told us that staff and managers always treated them well. One person said that staff usually treated them well. Six people said that staff listened and acted upon what they said. One person said staff sometimes listened. A member of staff told us that the staff team was very stable. Many of the team had worked at the service for a number of years, so were experienced and well trained. They said that the whole team was very committed to the ethos of the service. We saw that staff were aware of peoples needs and felt strongly about enabling people to reach their full potential. We saw that staff communicated with people well. One person was seen to be given time to answer questions without the staff member speaking for them. The staff member rephrased and repeated back sentences to check understanding. We saw that some people were asked questions, such as whats the time XX in order to promote involvement and decision making. We saw one person talk to staff about their rehabilitation programme and the progress they were making. In relation to what the service did well, the AQAA stated Home Managers involved in new staff recruitment and interviewing. A buddy system to support and orientate new Staff. All new Staff are supernumerary. Orientation and induction training for new Staff Mandatory Training and further relevant training for all current Staff on site. PDP files and Staff supervisions and appraisals. Internal promotion opportunities for non qualified staff. The AQAA confirmed that all new staff were fully checked to ensure their suitability of working with vulnerable people, before commencing employment. We looked at documentation showing the recruitment procedures of the two most recently appointed staff members. The staff files were ordered, well maintained and contained all of the required information. There was an application form and two written references. There was a health declaration which demonstrated that the applicant was both physically and mentally fit to do the job. A copy of the questions asked at interview and the applicants answers were in place. We saw that the questions asked were detailed and comprehensive. This enabled clear information to be gained from the applicant in order to assess their suitability for the post. Documentation showed Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: that applicants had an Independent Safeguarding Authority Adult First check and a Criminal Record Bureau Disclosure in place. The Human Resources Manager told us that in the event of a caution or conviction showing on an application form, the matter would be discussed with the applicant. A formal risk assessment would then be undertaken on receipt of the applicants CRB disclosure. We advised that the risk assessment be formally completed when the caution or conviction was first declared. The Human Resources manager told us that the recruitment policy would be updated to reflect this practice. The Human Resources Manager told us that newly appointed staff were always fully supervised until their CRB was received. We said that documentation should evidence this. The AQAA stated that over the next twelve months it was expected that Managers were to become even more involved in the interviewing process. This included advertising for specific job roles and different units. Staff told us that staff training was given high priority. They said there was a training department on site and regular courses and updates were sent to the service. Staff could then choose what training they felt they needed or wanted to complete. Staff told us that there was a range of both mandatory and other training available. Such subjects included diabetes, epilepsy awareness and cognitive rehabilitation therapy. They said that health care professionals from other parts of complex also did specialized training such as eating, drinking and swallowing. The training records did not demonstrate that this training had taken place recently. Within one staff record, we saw that the member of staff had only completed health and safety and fire safety training in 2009. There was no other training evidenced. Another staff training file showed more mandatory training had been undertaken. This included manual handling, safeguarding vulnerable adults, first aid and infection control. There was no evidence of other more specialist training. The AQAA stated that eight out of the nineteen staff had a National Vocational Qualification (NVQ) level 2. Staff told us that they received regular support and formal supervision. Documentation demonstrated that a system was in place yet it was not undertaken at the recommended frequency. Some sessions showed fifteen minutes duration. We saw that sometimes the session was used to discuss or gain feedback about a situation or the observation of a particular practice. We advised that the system be further developed to include ongoing action plans and agreed timescales. We saw within one record that a member of staff had requested medication training and support in leading a team. There was no evidence in the staff members training record that their request had been followed through. We saw that one staff member had an acting senior role. There was no evidence that they had been given training in relation to Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: their new senior responsibilities. At the last inspection, we recommended that management training be provided to all staff who were in charge of a duty shift. We did not see that this had been arranged. We saw that each staff member had a personal development plan reflection format on their file. The format gave a number of closed questions. One question was did you manage to achieve your goals? The staff member had recorded no. The format then stated why not? Staffing levels were given as the answer. There was no information about what the staff members goals were. The reasons that they were not reached were not expanded upon. The achievements for the following year were identified yet it was not clear how they were to be achieved. Target dates were stated as on going. We advised that the depth of this information be further developed to enable staff development to be structured and ongoing. In relation to equality and diversity, the AQAA stated regular Staff training and NVQ opportunities for all designations of Staff. Multi Cultural workforce. Equal opportunities policies and procedures regularly updated to incorporate changes in legislations. Disability award gained. IMCA services obtained to work with our service users who require them. Family liaison person to work with the social work Team and Service Users and Families. Care Homes for Adults (18-65 years) Page 33 of 40 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. People benefit from an organised, well managed service. People are encouraged to give their views and benefit from the ongoing development of service provision. People are protected through the clear health and safety systems in place. Evidence: Ms Broadhurst was appointed acting manager in September 2009. Previous to this, she had worked at the home as a deputy manager. Ms Broadhurst said that she was in the process of registering with us to become the registered manager. She said she had started her National Vocational Qualification level 4. Training records showed that she had also undertaken in house training in topics such as manual handling, fire safety, safeguarding vulnerable adults and first aid. The AQAA stated that clinical governance meetings had been improved upon in order to develop the managers knowledge and skills. Ms Broadhurst showed that she was very aware of peoples needs and was committed to developing the service. Ms Broadhurst told us that there was a quality assurance system in place. Documentation showed that the last care audit was undertaken in August 2008. Full Care Homes for Adults (18-65 years) Page 34 of 40 Evidence: compliance was noted. We saw that an infection control audit was undertaken in August 2009. A pharmacy audit was completed in December 2009. Ms Broadhurst was not aware that surveys had been sent out to people in order to gain their views. Mr Norman told us that the quality assurance systems were being reviewed. Maximizing peoples involvement in developing the service was planned. Ms Broadhurst told us that her next focus was to look at ways of enabling people to have greater leisure opportunities in the evenings. As part of the quality auditing system, regular meetings were held in order for people to give their views about the service. We saw that from September 2009, the content of the meetings were documented. Before this, there was limited evidence that the meetings took place. Ms Broadhurst told us that during this time, there were difficulties in recruiting an occupational therapist. Due to this, some of the meetings did not taken place. We saw that there was only one up to date record of a staff meeting. Ms Broadhurst told us that as with the other meetings, staff meetings had slipped. She said they were now back on track. The AQAA stated that as a result of listening to people, there had been a number of developments made to the service. These were stated as more social activities at the weekends for Service Users who do not go home including community access/shopping trips. Timetabled 1-1 time with the Home Manager on a regular basis to allow the opportunity to discuss any problems/concerns. A larger laundry/therapy room to enable wheelchair service users to partake in more activities of daily living and increasing independence. We saw that clear, ordered records demonstrated the senior managers unannounced visits to the service, which were undertaken as part of regulation 26. Staff told us that the sites maintenance team took responsibility for all the health and safety checks of the environment. This included the testing of the fire alarm systems, the emergency lighting and the monitoring of the temperatures of all hot water outlets. Clear records were maintained of all tests undertaken. The records showing hot water temperature testing were sent to the complexs central office, at the end of each month for monitoring purposes. The fire log book showed that regular fire drills took place and fire safety training was arranged. At the last inspection, we recommended that the staff who worked on night duty, should have fire training at intervals of four times a year. Ms Broadhurst told us that she was not aware of this but would make sure the recommendation was addressed without delay. There was an up to date fire risk assessment in place. Mr Norman told us that an external consultant had completed this. The consultant also completed regular health and safety audits of the service. Records demonstrated the servicing of all equipment. Care Homes for Adults (18-65 years) Page 35 of 40 Evidence: We saw that the service had a range of health and safety policies in place. There were also a range of environmental risk assessments. The assessments had been regularly reviewed and updated yet many were originally written in 2005. We advised that the assessments be rewritten when next reviewed. We saw that there were clear guidelines for staff, in relation to their responsibilities when facilitating specific activities such as swimming. As stated earlier in this report, individual risk assessments, which related to people and their activities, were comprehensive and well written. Care Homes for Adults (18-65 years) Page 36 of 40 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 13(3) Suitable cleaning implements 31/05/2007 must be provided, to ensure that the areas between the washing machines are clean and free of dust and debris. Care Homes for Adults (18-65 years) Page 37 of 40 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 6 When a person who is susceptible to weight loss, loses weight, the control measures in place should be reviewed and re devised. Any incident which adversely affects the persons well being should be addressed within the risk assessment process. Social activity provision for those people who do not actively participate within a rehabilitation programme should be reviewed to ensure the individuals needs are met. Consideration should be given to enabling people to cook their own lunch time meal rather than relying on the meal delivery service from the central kitchen. Adequate containers should be available so that laundry is not placed on the floor. A risk assessment regarding transporting laundry to and from the ironing/storage room should be undertaken. Those staff members who take the responsibility of running a shift, should receive management and leadership training Page 38 of 40 2 3 6 12 4 17 5 6 7 30 30 32 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 to ensure they have the skills to manage effectively. 8 32 When staff identify in their supervision session, what training they need to do their job effectively, this should be arranged and documented within their training file. A review of staff training should take place so it is identified what training staff need, in order to update their learning and development. A formal, written risk assessment should be undertaken when an applicant first declares a caution or conviction rather than waiting for the detail to be clarified on the applicants CRB disclosure. One to one formal supervision with staff should be formalized further. It should be consistently undertaken at the recommended frequency, be ongoing and contain measurable targets, which are reviewed at the next session. The environmental risk assessments should be rewritten when next reviewed. 9 32 10 34 11 36 12 42 Care Homes for Adults (18-65 years) Page 39 of 40 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). 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