Care Home: Palm Care

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What the care home does well People say they like living and working at the home The staff and service users enjoy each others company There are enough staff to support the people who live at the home, There are lots of activities and things for people to do at the home. People are encouraged to have a say in what goes on at the home and in their lives. What has improved since the last inspection? We were told that the new format for care plans (MY Plans) are clearer and easier to understand. People are contributing to daily records, saying how their day went and what they did. Staff have undertaken Makaton training to help them communicate with the service users. The manager has moved the office to a larger room. There is now room for more than one person to sit. The manager said that people now come in and talk to her rather than stand at the door. What the care home could do better: The home acknowledges that progress is still being made with the My Plan person centered approach as they are in the early stages. They intend, through improving communication skills, to better engage and involve the service users at all levels. The diverse nature and needs of the service users would benefit from more 1 to 1 time, to develop social and educational activities. Key inspection report Care homes for adults (18-65 years) Name: Address: Palm Care 12 Hardy Road Greatstone New Romney Kent TN28 8SF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Geoffrey Senior     Date: 3 0 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Palm Care 12 Hardy Road Greatstone New Romney Kent TN28 8SF 01797367006 01797367006 palm@caretech-uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Palm Care Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Palmcare, Hardy Road is registered as a Care Home for up to six adults with a learning disability. Palmcare Ltd is the registered provider and is a subsidiary of Care Tech Ltd. There is no Registered manager. A person is in charge of managing the day-to-day functioning of the home. The home is a detached property set in a residential area of the seaside village of Greatstone. The accommodation comprises six single bedrooms for the service users. There is a lounge to the front of the house and a larger lounge/dining room with access to the enclosed rear garden. Car parking is available to the front of the property. Local facilities (shop, church, pub, post office and GP) are all within walking distance. The reported fees for this service are between £1375.65 and Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 6 Brief description of the care home £1585.40per week dependent on assessed need. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home on 23rd April 2009. Palm Care is a small community home and at this time there were not many people in. The Manager and staff member on duty were able to answer our questions and give us some information. As we needed to spend more time speaking with the manager and wanted to meet and talk with all the people who live at Palm Care, we decided to leave after about two hours and arranged to come back another day. We visited again on 30th April 2009 . This time the Manager and three staff were in the house as well as four people who live there. We talked with three of the service users,including some time spent sitting with a member of staff and a service user who cant hear or speak very clearly so is helped to say what they want in other ways. We spoke with the Manager who helped gather information that we asked for. This was her first experience of a CQC visit since becoming manager at Palm Care. Staff told us Care Homes for Adults (18-65 years) Page 6 of 27 that they enjoyed working at the house and that things have gone well since the manager arrived in March. The previous manager left in September 2008 and in the interim period the staff were supported by an acting manager and the area management team. Everyone was now settling in and working together to make Palm Care a good place to live and work. We had a look round the home, all of the service users said that we could see their rooms and then one showed us other parts of the house. As well as the information collected on the day we also looked at the Annual Quality Assurance Assessment, AQAA. The Area Manager had completed this in January 2009. The Manager verbally updated some of the information and confirmed that the checks and service certificates were still in date. The last unannounced key inspection was carried out on 23rd April 2008. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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. Information is made available to help people decide about living at Palm Care. Admissions to the home are not made until a needs assessment has been completed and the home feels it can offer the required level of support. Evidence: The people who live at Palm Care have all been there for some time as there have been no admissions for at least two years. The manager said that there are two vacant rooms at the moment. The Manager is involved from the first approach for a place and has a major role in assessing and decision making. We were told that people who are interested in living at the home, whether they are already known or not, would have a full assessment of support needs and a thorough introduction period to make sure everyone is happy that it is the right place to live. The suitability of the placement is regularly reviewed and people are helped to move if it does not work out. People we spoke with said they were glad to have moved in as they like the house and the people who work there. One said he was happy and settled and another said he likes living there and there are lots of things to do. A Statement of Purpose, Service User Guide and complaints procedure are all in place and available. They are however Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: being updated with details of new staff and information about the Mental Capacity Act and Deprivation of Liberties Safeguards. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that choices will be offered and they will be supported by staff when making decisions.Staff have access to information and guidelines to help them when they are supporting service users. Evidence: The Manager told us that the current support plans, guidelines and personal information is all being brought together in single My Plan folders. These offer a more individual, personalised approach to obtaining and recording information. Staff said that the way support for the service users is described, in more manageable, clear, guided steps helps every one to understand them better and offer a more consistent approach. Keyworkers are working closely with the service users to find out who and what is important to them and recording how they liked to be supported with their care. We looked at some of the information in the folders and one service user sat and showed us the pages he had worked on with staff, to write down his goals and dreams, things he likes and does not like, and photos of special people. Another service user told us about the holiday he had chosen, where and with which staff. A Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: third is having a trip to a concert as a result of talking with staff in the My Time one to one sessions with his keyworker. Risk assessments are included as part of the support plans. These are written to help keep people safe in what they choose to do. We saw that service users are involved in making choices about things that affect their daily lives such as where to go and what to have to eat, as well as helping prepare the food. They also told us about other things they are able to have a say in. Everything is important, nothing is too trivial. One, for example, has chosen to spend his money on things for his bedroom. Another has chosen to go somewhere different for his haircut. Care Homes for Adults (18-65 years) Page 13 of 27 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 in the home are supported to lead busy and interesting lives. They are helped to keep in touch with family and other people important to them. They have food that they enjoy and is well balanced. Evidence: People said that they could stay up late or have a lie in if they wanted to and although there are some routines, like mealtimes and helping around the house, everything is fairly flexible. The manager said she was pleased that staff are now finding more things to do with the service users or helping them think of things to do for themselves. She felt that the number of staff on duty meant that they have opportunity to spend time with individuals, working on the personal plans or supporting activities in the house and in the community. On both visits, people were out with staff at some point in the day. All had a choice and could choose not to go if they did not want to. There seems to be plenty going on and although someone may Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: change their mind, there is a folder detailing activities so people know what is planned and with whom on any particular day of the week. Staff talked about how they are getting the service users used to the idea of looking back, and encouraging them to help record what they have done and what they got out of their day. People are helped to keep in touch with their family and friends. The names of people who are important to them are noted in their My Plan folders. Staff help with taking people to visit or visitors may come to the home if service users want them to. Staff and service users get together to plan the menu. Each persons choice is highlighted in a different colour on the menu plan for the week. They then shop for, and may help prepare, the lunchtime snacks and main meals of the day. Staff help with the choices to make sure every one has a well balanced diet. We were told, and saw, that any particular likes, dislikes allergies or special needs are recorded in individual files and are catered for. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare support is offered according to the varied and individual needs and preferences of the people living at Palm Care. Evidence: Staff talked about how they have got to know how each of the service users like to be supported with their personal care. Peoples privacy is respected. Some need more help than others but each is only given as much as he needs. Each person has their health needs and any support they may require noted in their care plan. Guidelines have been written so all the staff should be doing the same thing. People have notes and record charts so that the information is there to hand if they need to see a GP or specialist. Staff will help service users to attend GP, dentist or other healthcare appointment whenever they need it. The manager was able to comment on the current health of all the individuals and gave an example of positive progress one service user was making following a review and then change of medication. At the moment no one living in the home looks after his or her own medication. The manager told us that, in order to offer more privacy, service users medication is now kept in secure cabinets in their own rooms. Medication administration records were clear and up to date. The Manager reported that she is satisfied that the staff members involved Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: with medication have undertaken training and satisfied competency assessments. Care Homes for Adults (18-65 years) Page 17 of 27 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. If people have concerns about their care or safety they, or people supporting them, know what steps to take and who to go to. To avoid the risk of harm, the company undertakes checks on people who want to work at the home before they are allowed to start. The home maintains records to show that service users financial interests are protected. Evidence: Staff we spoke to were clearly aware of their responsibility to keep people safe from the risk of harm. They have attended Protection of Vulnerable Adults, POVA, training and were clear how they would proceed if they felt there was a risk to the people living at the home. They would not hesitate to contact the manager, Providers or Local Authority. Two service users said that they would tell the staff or the manager if they were worried about anything. Staff said that they knew what signs to look out for if a service user who is not able to speak out was in any way distressed. The organisation makes sure that anyone coming to work at the home has been thoroughly checked out before they are allowed to start work. There was a safeguarding vulnerable adults (SVA) alert raised during the last 12 months. This was when the same Provider but a different manager was in day to day control of the home. The matter has been closed. The new manager said that having a settled staff group with more training, improved communication and guidelines has helped to lower the number of incidents and the atmosphere in the home is now generally quite calm and positive. The Manager told us Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: that she keeps a close check on peoples personal monies and ensures that all cash transactions are clearly recorded and balanced. We saw records detailing monies credited to each service user, monies that had been spent by them or on their behalf and the receipts that had been retained. We were told that one service user likes to manage his own monies. He and a member of staff were seen making arrangements to go to the bank so he could withdraw monies to pay a bill. Care Homes for Adults (18-65 years) Page 19 of 27 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 house is homely, well maintained and comfortable and provides a pleasant environment in which to live and work. Evidence: All the service users have their own bedroom. We were able to see three of them. One person said he liked living there and had just bought some new things for his room. Another showed us all the things he is able to have around him and on display on the walls. Nowhere is out of bounds but staff explained how they safeguard people by supervising some activities in the kitchen and laundry area. There is a good-sized garden and everybody is encouraged to play a part in its upkeep and maintenance and use it for recreation and barbeques. Everyone helps to keep the home clean and tidy. The manager told us that safety checks are carried out and there is a maintenance programme in place. We were informed that there is some work being undertaken but yet to be completed on the fitting of noise activated door stops. Care Homes for Adults (18-65 years) Page 20 of 27 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 who live at the home are supported by a staff team who are safely recruited, receive training and support and know what is expected of them. Evidence: The home has a team of ten staff working day and night in the home to support the people who live there. There is a clear staff rota in place so people know who will be supporting them. The rota plans for at least three staff plus the Manger on duty during the day and two on the premises at night. All staff have the right checks in place, Criminal Record Bureau - CRB, references, induction and basic safety training. They are then encouraged to enrol on an NVQ programme. NVQ is a qualification that is work based and shows that staff have the right skills for the job. They are graded; the minimum for care support workers is level 2, managers generally have level 4 or higher. We were told that, of the 10 staff, 5 have NVQ level 2 or above. A further 3 have started a level 2 course.. We spoke to staff who said that they can attend further training in specific areas so they can support the people who live in the home with more confidence and expertise. One of the most recent courses for staff was Makaton. This has improved communication between staff and one service user in particular. It has lessened frustration and increased understanding. Staff told us that they have regular supervision with the Manager so they can discuss how they are working and what training they might need. They also have staff meetings to talk about how the Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: home is doing and make plans to improve or change things. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced and qualified individual manages the home with support from the Organisations Management and Quality Assurance team. The manager needs to complete the Registration process but is running the home in the interests of the service users. People are asked about how things are going and are involved in the decision making process.Health and Safety training and checks are in place. Evidence: The Manager has been working at Palm Care since March 2009. She has several years experience supporting people with learning disabilities and has worked as a manager for 3 years with another company and 2 years with Beacon Care. She has attained NVQ level 4 and the Registered Manager Award. She said she would make an application for registration. She organises her work so that she can spend time supporting service users and staff in their daily activities. Following her arrival at Palm Care a lot of her time was reportedly spent working closely with the staff and the service users, helping them to gel as group and be confident and comfortable in each others company. The ethos of the home ensures that people living there are routinely consulted and are encouraged to make choices. Monthly monitoring visits to the home Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: are carried out by senior managers, ensuring that the standard of care and documentation is maintained and the premises are in good order. The home is also regularly visited by, or asked to report to, the Organisations Quality Assurance managers. They will, by various means, check on the service provided and ensure that it continues to run in the best interest of the people who live there. They make sure service users and staff are given help to have a say in how things are decided and what plans are to be made for the improvement of the service. The current area manager completed the AQAA in January 2009. He confirmed, at that time, that safety checks and equipment maintenance was all satisfactory and up to date. Staff training includes measures to protect the health, welfare and safety of service users, staff and visitors. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 26 of 27 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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