Care Home: Paradise House

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• 2 Perhaver Park
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What the care home does well A comprehensive assessment and admission process minimises the risk of people being admitted to the home whose needs cannot be met. Care plans provide the staff team with sufficient information to allow them to support people consistently. The range of activities available to people on and off site is led by the needs and wishes of the people living at Paradise and continues to grow. Educational and work opportunities are offered to people. People said they enjoy going to social clubs, swimming and the gym. Observations throughout our visit provided evidence that people are treated with respect and involved in the day-to-day decisions in their homes. People live in homely, comfortable and clean environments that are being adapted to make sure it meets with their current needs. Staff have access to a wide range of training to meet the needs of the people living in the house groups. The monitoring Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 systems introduced by the manager enable them to oversee the practice of staff across the site and are forming the basis of the home`s quality assurance. What has improved since the last inspection? Requirements issued to the home whilst registered as The Paradise House Association had been complied with. What the care home could do better: People`s preferences about the gender of staff providing their personal care should be recorded in their care plans. The systems for the administration of medication need to be more robust to make sure people are not at risk of possible harm. A report needs to be produced to reflect improvements in the service as identified through the quality assurance system. Key inspection report CARE HOME ADULTS 18-65 Paradise House Paradise Painswick Gloucestershire GL6 6TN Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 28 and 29th July 2009 09:30 th Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 2 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 Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paradise House Address Paradise Painswick Gloucestershire GL6 6TN 01452 813276 01452 813372 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Novalis Trust Ltd Miss Alison Hurlock Care Home 30 Category(ies) of Learning disability (30) registration, with number of places Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 30. Date of last inspection NA Brief Description of the Service: The Paradise Community is situated outside the village of Painswick and consists of four houses. The site also contains gardens, workshops and offices. The Community is registered to accommodate 30 adults who have a learning disability. Novalis Trust is a Registered Charity and has a Board of Trustees. It has another small registered care home locally. The Community aims to provide long term residential care, education and occupational opportunities within a home setting based on the care and educational values and teachings of Rudolf Steiner. The nearest local amenities are situated in the village of Painswick approximately a quarter of a mile away, with the larger towns of Stroud, Gloucester and Cheltenham being within easy commuting distance. Each person has a personal copy of the current Statement of Purpose and Service User Guide. Other copies are available from the office. Fees for the home range from £910 to £2,500 per week. Additional charges include payment for use of the home’s transport which is calculated according to each person’s use of the vehicles. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. 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 views and experiences of people using the service. This inspection took place in July 2009 and involved two visits to the home and administrative headquarters on 28th and 29th July by one inspector. This was the first inspection of the home since Novalis Trust was registered with us (the Care Quality Commission) as the registered provider of the home. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). As part of the inspection we spoke with people living in the home, talked to staff about the care provided and observed people being supported. We talked to 4 people living in the home, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. Prior to the visits we had received surveys from 8 people living in the home, 6 staff, and health care professionals involved in the care of people. We examined a range of documents and spent time with staff who had responsibility for collating these such as health and safety, recruitment, training, care and finances. What the service does well: A comprehensive assessment and admission process minimises the risk of people being admitted to the home whose needs cannot be met. Care plans provide the staff team with sufficient information to allow them to support people consistently. The range of activities available to people on and off site is led by the needs and wishes of the people living at Paradise and continues to grow. Educational and work opportunities are offered to people. People said they enjoy going to social clubs, swimming and the gym. Observations throughout our visit provided evidence that people are treated with respect and involved in the day-to-day decisions in their homes. People live in homely, comfortable and clean environments that are being adapted to make sure it meets with their current needs. Staff have access to a wide range of training to meet the needs of the people living in the house groups. The monitoring Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 6 systems introduced by the manager enable them to oversee the practice of staff across the site and are forming the basis of the home’s quality assurance. 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. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. A comprehensive assessment of the person’s wishes and needs are taken into consideration before offering them a place. EVIDENCE: A new Statement of Purpose and Service User Guide had been produced in line with the Care Homes Regulations providing people with information they need about the service they will receive. A DVD had been produced for a summer fete and could be used for people wishing to move into the home to sample a visual overview of life in the home. Staff said they had discussed producing the Service User Guide eventually in this format. The admission information for one person who had recently moved into the home was examined. Comprehensive information had been obtained from their former placement including a copy of the last assessment of need and care plan from the placing authority. The home had requested an updated copy of this assessment from the placing authority but had not yet received this. They Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 9 were keeping a record of all interactions during the admission process providing evidence of when they had requested information and when it had been received. The home had completed their comprehensive assessment of the person’s needs and had also asked the parents of the person to complete an assessment providing additional information. A pre-review meeting had been planned with the person to discuss their first weeks at the home and their wishes and aspirations for the future. An initial placement review had been arranged to include the placing authority and their parents. There was evidence that transition meetings had been held with people involved in the care of the person prior to visits being arranged to the home. Planned visits were then completed including a full week assessment. Records were kept throughout building a picture of the person’s needs. A copy of a letter was seen stating that the home were able to meet the person’s needs. The person was observed in their house and appeared to have settled in well and to be happy and confident with their new routines. Each person had a copy of a statement of terms and conditions in place describing the service they should expect to receive. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being involved in developing their care plans that reflect their aspirations and needs. Plans reflect the diversity and individual expectations of people. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care of four people in each of the four houses was case tracked and other files sampled. Each person had a care plan which included an assessment of need and identified goals and strategies to meet these. Staff described the process whereby people were involved in this process starting with the prereview meeting where they discussed their wishes, aspirations and needs. People were then supported at their formal annual review to discuss these and formulate a new plan. After this meeting they had another discussion to talk about what had gone well at the meeting and any concerns they may have. Care managers commented that the home provided ‘a very holistic, caring and Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 11 totally professional service’ and that there were ‘good person centred plans’ in place. Plans were being reviewed at least six monthly and more often where changes in need had occurred. Plans provided staff with succinct guidance about how to meet people’s needs and clearly cross referenced with additional information such as risk assessments, specific guidelines (e.g. diabetes, Prada Willi) and physical intervention protocols. Staff spoken with had a good understanding of the needs of the people they support reflecting guidelines noted in their care plans. Daily records were logged in ‘Blue books’ with copies of these being taken to the office where any concerns or incidents were highlighted to be discussed at the weekly welfare meetings. These meetings provided a forum for managers to discuss people’s needs, provide advice or clarification to care staff and to make referrals to other health care professionals such as the local Community Learning Disability Team. Minutes of these meetings were provided to each house and day services promoting consistency and continuity of approach by all staff. Each person had a communication care plan which indicated their preferred form of communication, how to understand non verbal behaviour and strategies to promote positive communication. Staff were observed using Makaton sign language with people. The registered manager said that choice was offered by using objects of reference and that they were looking at greater use of photographs to enable people to express their needs. This should be explored for people who have limited verbal communication or whose needs may be changing due to dementia. Good use was being made of DVD’s and film to illustrate people’s lifestyles and their experiences at the home. There were very few restrictions around the home, but those that were in place such as restricting access to the kitchen during food preparation or restricted access to food in kitchens were recorded with the rationale for these clearly explained. The missing person’s procedure had recently been reviewed and risk assessments were in place for people for whom there were concerns when out in the local community indicating the levels of support needed. Risk assessments acknowledged hazards and indicated how these should be minimised to prevent harm to the individual. Risk assessments promoted people taking measured risks as safely as possible. For instance one person had recently been supported to catch the bus into Stroud on their own. This was done taking small steps with staff support gradually being withdrawn as they became more confident. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17. People using the 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 who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. EVIDENCE: Each person had been involved in developing an activity programme for their week. These were being reviewed every 3 or 4 months. The day started with a ‘gathering’ and people who choose to go to this congregate in the main hall. There was also a musical evening each week and opportunities to explore ‘story telling’ on another evening. Some people were being supported to attend local churches each Sunday. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 13 Paradise House had developed opportunities for people to undertake training and education on site. Qualified staff facilitated people to participate in an AQA programme of awards for which they can gain a certificate of competence. It is hoped to expand this to enable people to complete Entry Level Certificates in Art and Design and National Vocational Qualification Awards. People had also been able to participate in first aid training provided by Novalis Trust trainers at their Head Office nearby. Further training opportunities were planned in food hygiene. People were able to choose from a range of workshops each day including gardening, craft and textiles, pottery, weaving, IT, literacy and numeracy, independent living skills and dancing. Several people were attending courses at local colleges. Three people had completed an Interact Course in Stroud about sexual awareness and relationships. Some people had work placements both at Paradise House, helping the maintenance team or delivering the post and in the local community – helping at a Kindergarten or as a catering assistant in a local school. The AQAA indicated that there ‘is more consultation taking place with regards to the choices of activities/workshops’ and evening/weekend activities. Daily notes indicated the range of activities and leisure pursuits people were being involved in outside of Paradise House. People said they enjoyed going to social clubs to meet with other people and to use the gym and swimming pool in Stroud and Gloucester. They had been to a pop concert and trips to Swindon and London. People were observed planning a trip to the Waterways Museum in Gloucester and to go to the cinema. People were also observed discussing with staff changes to their timetable or cancelling a workshop. Their decisions were respected. People were planning holidays and day trips. Several people had bus passes and used local transport systems as well as the home’s vehicles. Staff commented in their surveys that more activities were being provided at the house and also in the wider community and this was confirmed by health care professionals. Staff indicated that lack of drivers could sometimes impact on access to community activities for some houses. After the inspection the manager commented that there were five vehicles on site, which many staff could drive, so this rarely happened. People have access to computer suites in two houses and each house has a television in the communal lounge with access to a DVD player. People also have DVD or Video players in their rooms. People were observed choosing where to spend their time when back in their houses, helping to prepare meals, getting drinks and snacks and chatting with each other and staff. Daily records indicated that people helped around their homes with the cleaning, cooking, laundry and recycling. Some people had facilities enabling them to become more independent with access to their own kitchens and living quarters. Staff described how they were encouraged to do their own shopping. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 14 During our visit some people were visiting with relatives and others were looking forward to seeing their family. People were also keeping in touch via telephone and email. Relatives and friends were being invited to social events at Paradise and were welcome to visit. The AQAA quoted one parent as saying, “I have observed happy occupied community members, who appear positive and interested in their lives at the community.” People were involved in growing their own produce which they then distribute to the houses. Organic produce was being purchased and freshly prepared meals and snacks offered each day. Menus were being discussed with people at their weekly house meeting. People were joined for a lunch of liver with bacon and sausage and vegetables followed by apple crumble. In another house fish pie had been prepared with an alternative meal for a person who disliked fish. Tea in another house was courgette soup and freshly baked bread. People said they buy snacks to keep in their rooms and can also make drinks in their rooms if they wish. Special diets were catered for with gluten free and diabetic foods being provided where needed. Advice from a dietician had been sought and followed to support people with a healthy diet. A Speech and Language therapist had also advised about a soft diet for a person whose needs were changing. Although individual meal records were not being kept, alternatives were recorded for those people who did not have a main meal. Monitoring forms were in place where there were concerns about nutrition. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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’s health and wellbeing are being met helping them to stay well. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. EVIDENCE: Admission assessments asked people to consider whether they have any preferences for male or female help with their personal care tasks. Although people had identified their choices in this matter this information had not been reflected in their ‘self care and basic care’ plans. The way in which people would like to be supported with their personal care needs was clearly identified. Care was taken to identify any specialist needs for people with diabetes, Prada Willi or allergies. Where people had epilepsy their care plans gave clear instructions about the support needed when bathing to minimise the risk of harm. Staff were observed treating people respectfully and explaining their behaviour or actions to people. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 16 The AQAA indicated that health professionals were being involved in all aspects of people’s health needs and that any recommendations they made were followed by staff. Care plans clearly identified where such guidance had been made and referred the reader to these documents. Health care professionals said the home ‘strives to support residents and staff in all aspects of wellbeing and ensure best practices are maintained. The standard of care provided by Paradise House is excellent.’ The home worked closely with the local Community Learning Disability Team and Novalis Trust had set up a team of health professionals to provide therapeutic support for people and staff. Appointment books were being maintained in each house providing evidence of appointments and their outcomes with a range of health care professionals. Discussions with the registered manager confirmed that these could at times be confusing and difficult to trace quickly when the last appointment was attended for instance with a Dentist. Health action plans were being introduced for people as they had their annual health check with their Doctor. Each house had its own supply of medication in a monitored dosage system. Staff had received training from a pharmacy and managers were also preparing to cascade training to staff using an open learning pack provided by the pharmacy. Audits of competency were carried out. A homely remedies list had been agreed with a Doctor and was about to be reviewed. Medication administration records were mostly satisfactory although staff must make sure that they sign and countersign handwritten entries. Allergies had not been identified on these forms. This section must be completed. A number of people had allergies identified in their care plans. Temperatures were not being recorded for cabinets and this had been identified as a shortfall by the home. New thermometers were being bought and forms would be put in place. It is advised that creams for internal/external use are separated and kept in sealed containers. The main house had dispensers into which staff said they were secondary dispensing medication when people went on social leave. This was contrary to the home’s medication policy and procedure. Our guidance was given to the registered manager about arrangements for taking medication on social leave and this must be adhered to. Additional training had been provided for staff supporting people with epilepsy where invasive procedures may be necessary and also supporting a person with diabetes. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the 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 service has an accessible complaints procedure which enables concerns to be raised by people using the service or on their behalf. Systems are in place which should safeguard people from possible abuse. EVIDENCE: Over a third of people who returned surveys to us said they did not know how to complain. Most people said they would talk to staff. The complaints procedure was accessible in the houses and people had weekly house meetings when they were able to discuss any concerns. Staff said that these were revisited each week so that people were aware of any action taken. House meeting minutes were kept in the office. The AQAA stated that people were being reminded several times throughout the year about the complaints procedure. People were observed talking to staff about concerns, being listened to and appropriate action taken. The Dataset indicated that the home had received 3 complaints, one of which was upheld. Staff had completed training in the safeguarding of adults and those spoken with were aware of the reporting of incidents in line with the home’s Adult Protection Policy. The registered manager had liaised with the local Adult Protection Unit and had completed training with them on the Mental Capacity Act and Deprivation of Liberty Safeguards. Best interests meetings had taken place and the registered manager said that assessments would be completed Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 18 for all people in relation to the support needed to manage medication and their personal finances. Staff had completed training in CALM (Crisis, Aggression Limitation and Management) and said that they rarely use physical intervention involving a two person removal. Care plans provided clear guidance about how to support people with their anxieties or anger, how to recognise triggers and what strategies to take to help them calm down. Staff were observed effectively putting this into practice during our visit. Most people were being supported to manage their personal finances. Records kept in the houses were inspected and found to be satisfactory. Staff said regular checks were in place at each handover and external audits were also in place. We spent time at Head Office looking at records and statements kept there. These gave a clear audit trail of money coming in and expenditures. New accounts were being set up for people. The registered manager said that some people had their own bank cards. Some parents were appointees for people living in the home and they were forwarded statements each month. People were observed talking to staff about any extra purchases they wished to make and being supported to access their savings. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the 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 live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: The extensive grounds and houses were in excellent condition during our visit. Considerable work had been done around the houses to improve the grounds laying new footpaths and tidying up flower beds and the vegetable garden. Additional access had been provided to the rear of the home with more parking. New signage had been designed to improve access around the site. The maintenance team deal with day to day repairs in the houses which were being recorded in logs in each house. As repairs were completed these were signed off. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 20 As part of the registration of the home an additional 6 new rooms had been made available around the site increasing the numbers of people able to live there to 30. These were inspected to ensure compliance with requirements made as part of our registration of these rooms. People commented that their houses were spotless now that they had a cleaner to help them. A generator had been installed to ensure continuity of electricity to the site and work was in hand to improve the electric mains supply. Ongoing improvements were in hand during our visit including creating a new lounge in the main house. Carpets were being fitted and new fixtures and fittings had been supplied. In addition the registered manager had highlighted the need to review the use of Tobias Cottage to provide accommodation to people with mobility problems. A wet room was being installed and a pedestrian walkway to the main house was going to be built. People had access to a pottery workshop on site and there were plans to develop the Coach House into a café. People were also able to use the training facilities at Novalis Trust’s Head Office. Plans to create a therapeutic centre here including a sensory room would also be accessible to them. In light of the heightened alert about swine flu, hand sanitizers had been made available at entrances to houses and other communal rooms. Soap dispensers and paper towels had been placed in communal toilets and near communal hand wash basins. Laundries examined were clean and appropriate infection control measures appeared to be in place. Staff were completing training in COSHH (Control of Substances Hazardous to Health) and hazardous products were stored securely. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with knowledge about the diverse needs of people living at the home. Robust recruitment and selection procedures should protect people from possible harm. EVIDENCE: The registered manager was supported by a senior team of managers to oversee care staff, training and recruitment and selection. We met with each manager to examine records and electronic databases. The DataSet indicated that 47 of staff had a National Vocational Qualification in Health and Social Care. Staff confirmed that a programme was in place enabling them to register for their awards after induction. Novalis Trust had become an accredited Centre for the delivery of NVQ Awards. All staff completed an induction in the home on their first day and then completed a six week induction which was equivalent to the Skills for Care Common Induction Standards. Staff said this included mandatory training and training in CALM. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 22 Files for three new members of staff were examined. Comprehensive systems were in place to monitor requests for information and receipt of records. These were recorded electronically as well as maintaining hard copies. Each new member of staff had completed an application form, any gaps in employment were questioned and evidence supplied to provide a full employment history. An occupational health questionnaire was completed and any additional support that may be needed for people was provided or the necessary risk assessments put in place. New staff were not appointed without at least two satisfactory references. Where needed additional references were obtained from previous positions in care to clarify the reason why they had left this employment. The registered manager confirmed that new staff would not be appointed without a Criminal Records Bureau (CRB) check in place but if they were a pova first check would be in place and they would be asked to sign a disclaimer indicating what duties they could not perform. A copy of this was seen. Proof of identity and a photograph were in place on all files. Where staff have come from oversees there was evidence that their visas were being monitored and police checks were being obtained. The registered manager confirmed that people living in the home were being involved in informal interviews of new staff as they visit the home. Robust training systems were in place for delivery and monitoring of training. Staff spoke positively about the training opportunities accessible to them provided by the organisation and external trainers/colleges. An electronic database provided evidence that the team were keeping track of staff training needs and reminding them when refresher training was needed. Training was being provided every Tuesday with additional training being scheduled during the summer months. When new people were being assessed to move into the home any additional training needed for staff was being identified and provided before new admissions moved in. Diabetes and Prada Willi training had both recently been provided. Likewise as people’s needs were changing additional training was provided for staff such as in Dementia. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the 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 management and administration of the home is based on openness and respect. Effective quality assurance systems are being developed involving people who live at the home. Systems are in place to maintain and monitor the health, safety and welfare of people, which should safeguard them from possible harm. EVIDENCE: The registered manager is a qualified social worker and has considerable experience supporting people with a learning disability. She was supported by a senior management team both at the home and based at head office. She Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 24 met with them regularly and closely monitored the support provided to people living in the home and the performance of staff. A quality assurance manager had been appointed and was conducting unannounced visits to the home with an external auditor as part of the Regulation 26 visits. Copies of reports were examined and confirmed that people living in the home were part of this process. The quality assurance system was being developed and included surveys of people and other people involved in their care, health and safety and financial audits. We discussed how this information would be collated and a quality assurance action plan or report produced which would be accessible to people living in the home. The registered manager said that they plan to review our AQAA every 6 months to ensure that the information in this document is up to date. Staff and management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. There was evidence that advocates were being involved with people where appropriate and the necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. A health and safety manager oversees the systems in place at the home. A current fire risk assessment was in place for each house. Fire drills and checks on fire equipment were taking place. Staff in the houses were monitoring and recording temperatures for cooked food, fridges and freezers. Water temperatures were being taken and recorded and water tested every three months by an external contractor. Monthly health and safety checks were being completed. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Version 5.2 Page 26 Paradise House DS0000073279.V376801.R01.S.doc NA Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement The registered person must make sure that medication is administered safely. This is in respect of completing medication administration records and to promote safe practice when taking medication on social leave. This is to safeguard people from possible harm due to medication errors. The registered person must make sure that as part of the quality assurance system a report is produced to give feedback to people living in the home. This is to demonstrate continual improvement and development of the service. Timescale for action 30/08/09 2. YA39 24 31/12/09 Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA7 YA18 YA20 Good Practice Recommendations Explore the use of photographs and symbol to illustrate documents and to promote choice for people with limited verbal communication. People’s preferences for the gender of staff providing personal care should be noted in their care plans. Consider how house meeting minutes could be made more accessible to people. Paradise House DS0000073279.V376801.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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