Care Home: Pathfinders Neurological Care Centre

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What the care home does well People live in a comfortable and well designed environment, that offers a professional and friendly approach to care. They are supported to make their own decisions and choices about their lives, and take a part in the development of the services they receive. The home encourages the involvement of people`s families and friends in the day to day support, and it offers a wide range of activities and therapies which help people to maintain their independence and develop their social lives. Staff are recruited safely and they have access to a varied programme of training, which means that they have a good understanding of people`s needs. Robust management systems, including the assessment and care planning approaches help to ensure that people receive the care and support they need, in a safe and personalised way. What has improved since the last inspection? Since the last inspection in October 2008 the home has developed its systems and improved the service it provides. We carried out a random visit in February 2009 to monitor how the home was progressing. At that visit we found that the requirements made in October 2008, regarding care planning, testing of equipment, medication practices, staff recruitment and the providers monthly visits, had all been addressed. Since then they have maintained these improvements and continued to develop the services and facilities available to people. For example information about the home is available in various formats so that everyone can access it easily. What the care home could do better: We said that whilst care planning and review documentation in general is of a good standard, the home should review everyone`s personal files to make sure that there is a consistent approach to the level of detail recorded. This has already been identified by the home and there is a development plan in place to address the issue. Whilst there are clear support and development networks for staff, we said that they should have the opportunity to meet with their line managers on an individual basis to discuss their own needs and progress. The manager said that they will look at ways to do this. Key inspection report Care homes for adults (18-65 years) Name: Address: Pathfinders Neurological Care Centre Darwin Drive New Ollerton Nottinghamshire NG22 9GW     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: Dawn Podmore     Date: 1 6 0 8 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 26 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 26 Information about the care home Name of care home: Address: Pathfinders Neurological Care Centre Darwin Drive New Ollerton Nottinghamshire NG22 9GW 01623836639 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.pathfinders-care.co.uk Pathfinders-Care(Ollerton)Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 44 The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Physical Disability - Code PD Date of last inspection Brief description of the care home Pathfinders Neurological Care Centre is purpose built and located in sizeable grounds on the outskirts of Ollerton. Local amenities include shops, churches and pubs. The home has a level entrance access directly into the reception area. There is a passenger lift that is accessible to wheelchair users. The accommodation is on two floors. There is a large communal room with access to the main kitchen. In addition, Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 0 44 44 Brief description of the care home there are two kitchen/diners and small lounges on each wing and the building is well served with dedicated areas for activities, therapies and social function. There is under-floor heating with thermostatic control in each room. Bedrooms are large and airy and have TV points, satellite TV is available at an additional charge. They also have telephone points so that people have the option to have their own telephone with responsibility for the line. There are views from all windows overlooking the grounds. At the time of our inspection there were 44 people living at the home. The manager told us that fee rates range from £550 - £3130 per week, depending on peoples assessed needs. There are extra charges for things like specialist therapies, such as physiotherapy, special outings and events, hairdressing and toiletries. Further information about the care home is available at the home or on their website www.pathfinders-care.co.uk Care Homes for Adults (18-65 years) Page 5 of 26 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: The visit to this home took place over one day in August 2010. It was announced, and followed on from a previous visit carried out in March 2010. Two inspectors carried out the visit. We followed, in detail, the care and support received by four people who live at the home. This process is called case tracking. We looked at their personal files, we spoke to them, we spoke to the staff who support them, and we watched how staff provide support to them. We also spoke to other people who live at the home, their families, and staff members in general. We spoke to senior members of staff, including the manager and the owner. We also looked at a range of records which show how the home is managed, and how people who live there are able to contribute to the running of the home, and the development of the services they receive. Care Homes for Adults (18-65 years) Page 6 of 26 One person who lives at the home told us I cant put into words what they have done for me. Care Homes for Adults (18-65 years) Page 7 of 26 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 26 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 26 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. People are assured that their needs and expectations will be met by way of robust assessments. Evidence: We looked at the initial assessments that people had when they first came to live at the home. We saw that the assessments were detailed, and described what support the person required to meet their needs. They covered essential areas such as behaviour, psychological needs, communication, physical health and personal care, as well as peoples expectations. One relative told us that the admission process was brilliant and said, there were bags of people to help move her in, I couldnt fault how they settled her in. Relatives also said people answered questions honestly and didnt go over the top. Care Homes for Adults (18-65 years) Page 10 of 26 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 receive the care and support they want, in the way that they want it. Evidence: Peoples care plans incorporated their assessed needs and wishes. Care plan files are separated into three sections to do with medical needs, well-being and activity needs, and personal information. Most of the plans show staff how people like to have their needs met, and there is a lot of detail about how to do this. One plan did not have as much detail about specific areas of need or their personal preferences, however assessments did contain this information. Senior staff told us that they have identified the need to add more detail to peoples files, and the homes development plan shows that they are addressing this issue. The records also show that care plans are reviewed at least every month, however the contents are brief and do not show exactly what progress is being made. One person said Ive got my plan and they ask me if its OK and I can change what I want. We also saw that people or their relatives sign the care plans where they are able to, to Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: show that they agree with them. A relative told us that the staff encouraged people to make their own choices, and we saw staff offering people choices in the way that suited them, for example using signing. Care files contained assessments of peoples capacity to make decisions and choices for themselves, and there were care plans in place to show how to help people if they could not make their own decisions. We saw risk assessments in each care file that covered needs such as bed rail use, nutrition, pressure area risk, and moving and handling. They were very detailed and identified for example, how different types of equipment should be used. People who live at the home and their relatives told us that they were kept well informed about changes in peoples condition. They complimented the level of support people received and the way in which staff delivered care. People spoke positively about their experiences at the home and said that their needs were met to a high standard. We saw that staff have a very good understanding of peoples individual needs for example, how and where they like to sit, what activities they like to do, and how they like to dress. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to enjoy a varied and stimulating social life, that meets their needs and wishes. Evidence: Each person has a personalised activity and well-being plan. We saw that people join in with things like relaxation, cooking, art, skittles and film shows. People said things like theres a lot to do , there are things on the board and you can choose to do them or not. They also told us that there are trips out to local attractions, and one person said that they really enjoyed a recent trip to the seaside. We know that there has also been recent birthday celebrations, a tree planting and gardening day, and a visit from a member of the royal family.We saw that people have access to computers and a Wii, and they are fully supported to practice the religion of their choice. Relatives are given access fobs to specific areas so that they can visit people freely, Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: whilst security is maintained for people on other units. Relatives told us that they are made to feel welcome during visits, and they are offered a range of refreshments. Senior staff also told us that people are encouraged to make use of local educational opportunities. We know that people are able to discuss the types of activities that are offered at meetings, and can change their activity plans whenever they wish. The home employs a holistic therapist who provides a range of therapies such as relaxation. Records of participation are very detailed and enable people to monitor their progress and enjoyment. People said things like food heres great, and one person said, there is a lot of food available. We saw that meals were well presented and nutritionally balanced. People said that they can choose whatever they like to eat, and we saw a range of foods on offer at lunchtime. Each unit has two kitchen areas so that people can cook their own food if they wish. One person told us that he regularly shops for his own food and cooks for himself. Peoples care files contain clear and detailed nutritional assessments that allow staff to monitor their dietary needs and intake. Care Homes for Adults (18-65 years) Page 14 of 26 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. Robust care planning means that peoples health and personal needs are met in the right way. Evidence: The files we saw contained clear records to show that peoples health and personal needs are monitored closely by staff. Records were in place for monitoring things like epilepsy, personal hygiene, behaviour, skin care, and pain. Routine monitoring of peoples weight and blood pressure is also recorded. There is a physiotherapist available to help people, and records of this support are very detailed and individualised. Moving and handling care plans show staff exactly how to use specialist equipment in the way that the person likes and is safe for them. Each person is assessed on admission by the physiotherapist to make sure that they have the right equipment and support to be able to move in the safest way they can. People and their relatives told us that they have a very good service from the local GP surgery. We know that the home also provides a weekly clinic held by a Consultant Neurologist who specialises in rehabilitation. The manager said that he also provides case study training for the staff. Records show that the home has links with local Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: community nurses and with the local healthcare trust. Senior staff told us that the local healthcare trust has supported them to implement specific end of life care packages and they are soon to become accredited to use another end of life care system. People have a care plan to tell staff how they like to have their medication administered. The plans give clear instructions such as techniques to relax people and help them to swallow their medication. The care plans include protocols for medication taken only when needed, and the persons ability to make decisions about medication is also referred to in the plans. We saw staff giving out medication in the right way, and talking to people about their personal requirements in private. Staff demonstrated clear knowledge of peoples medication needs. Care Homes for Adults (18-65 years) Page 16 of 26 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. People are protected by robust systems and knowledgeable staff. Evidence: Our records show that there have been no complaints made to us about the service provided since the last inspection. The complaints policy is displayed for people to see, and one person told us if I dont like anything they do their best to sort it out. No one raised any concerns with us on the day of the visit. We know that five situations where people may have been at risk have been referred to the Local Authority Safeguarding Adults Team in the last year. People were found to be safe in all of the situations, however the home has taken action to resolve any issues the investigations highlighted. Records showed, and staff told us, that they have training about how to keep people safe. The Local Authority policy about how to keep people safe is freely available for people to refer to. Care Homes for Adults (18-65 years) Page 17 of 26 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 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 an environment that suits their needs and wishes, and allows them every opportunity to maintain and develop their independence. Evidence: On the day of the visit the home was clean, tidy and had a comfortable and friendly atmosphere. We saw that staff have access to gloves, aprons and hand cleansing gels. They were seen to use appropriate hand washing techniques. The environment has been purpose built to accommodate a wide range of physical needs. Doors, corridors, communal and personal spaces are designed to allow easy access for those people who use wheelchairs and moving equipment. Each unit has two kitchen areas where people can cook their own foods and make their own drinks. Kitchen fittings are designed with various heights of working surfaces, safe cooking surfaces, and washing machines. There are also two lounge areas in each unit which gives people a choice of where to spend their time. In communal areas there are windows that reach floor level so that everyone can look out on to gardens and surrounding park areas. Personal rooms were decorated to individuals tastes. We were told by staff that people Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: are given a choice of colour schemes and encouraged to personalise the rooms with pictures and ornaments. Windows have low sills so that people can enjoy the views from their own rooms. We saw that all of the bedrooms have en suite and showering facilities, and there are specialist baths, including a Jacuzzi bath, also available in each unit. Care Homes for Adults (18-65 years) Page 19 of 26 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 are supported by a safely recruited and well trained staff team. Evidence: We looked at four staff files that showed us information about how they are recruited, trained and supervised. Recruitment information includes things like references, application forms, and criminal record bureau checks. There are also records of interviews and clear identification. Training records show us that staff have a week long induction when they start work at the home. Staff told us that the induction helped them to settle into the job, and one staff member said that they had seen a huge improvement in the quality of the induction training over the past year or so. Staff also told us that they receive a good on-going training package which includes subjects like moving and handling, health and safety, medication and infection control. They also have training in specialist feeding techniques, first aid, and individual conditions that affect people who live there. Staff told us that they have access to nationally recognised care qualifications, and records show that all of the staff hold or are working towards the award. Staff told us that they have good support from the manager and senior staff, and one person said you are listened to and feel valued, and there is always someone to go Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: to. However there were no records to show that staff have regular, formal, individual supervision sessions. The manager showed us a spreadsheet outlining when staff had received an appraisal, but the content of staff files did not support that all staff had received an appraisal annually. For example one persons file indicated that their last appraisal was in 2008. Care Homes for Adults (18-65 years) Page 21 of 26 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. Peoples health, safety and welfare are protected by robust management systems. Evidence: The home does not currently have a Registered Manager however Dr Angela Nall is currently in the process of registering with us. People told us that things had improved since she became the manager and that they found her open and approachable. There is a quality assurance system to enable them to gain the views of the people who live and visit the home and assess how the home is operating. This included surveys, internal and external audits and regular meetings. One person told us about a comments box that was located in the reception area in case people wanted to raise any issues, although he said, I have never used it though. We sampled some of the returned surveys, which included some completed by people who had lived at the home on a short term basis. These contained positive comments that showed that people liked living there. One person said meets all expectations and another commented I hope to come again next year. The manager told us that Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: the outcomes were discussed during meetings, but at present no summary of the finds is published so that people could easily see what people thought about the home. This was something she said would be considered for the future. There is a maintenance team who maintain the building and check that health and safety guidelines are being followed. This included coordinating the servicing and maintenance of equipment. We saw that regular checks on equipment had taken place and things like the fire alarm system had been regularly tested. At the last visit by the Environmental Health Officer they awarded the home 5 stars for the systems and facilities they had in place, this is the highest rating that can be achieved. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 36 All staff should receive regular formal supervision sessions. These along with annual appraisals should be recorded in full in staff files. This will help to ensure that staff are being appropriately supported. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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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