Care Home: Peaklands

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What the care home does well People`s needs are thoroughly assessed before they move into the home. This helps to ensure staff know what support people need.Staff have a good understanding of people`s needs. This helps them to provide the support that people need.People are supported to take part in activities they enjoy and keep in contact with family and friends.Staff help people to receive the healthcare they need and to take their medication safely.People who live at the home feel staff treat them well, listen to them and act on what they say.Staff are thoroughly checked before they work in the home. This helps to keep people safe. What has improved since the last inspection? The home has been redecorated and the upstairs bathroom has been made more accessible for people.Staff have received more training about people`s specific needs. This helps to ensure they have the right skills to meet people`s needs. What the care home could do better: The care and support plans need to include information about all the needs identified for people. This will help to ensure all staff provide the right support. Key inspection report Care homes for adults (18-65 years) Name: Address: Peaklands 73 The Avenue Fareham Hampshire PO14 1PE two star good service The quality rating for this care home is: 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: Craig Willis Date: 2 7 0 8 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 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 Information about the care home Name of care home: Address: Peaklands 73 The Avenue Fareham Hampshire PO14 1PE 01329238946 F/P01329238946 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.hampshirepartnership.nhs.uk Hampshire Partnership NHS Foundation Trust care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. 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 A bit about the care home Peaklands is a large detached property set in its own grounds approximately two miles from Fareham. It is registered to provide care and accommodation to five people with learning disabilities. Local shops and other amenities are nearby, and residents have access to public transport. Each person has their own bedroom and share the use of bathrooms, lounge and kitchen / diner. 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 How we did our inspection: This is what the inspector did when they were at the care home We visited Peaklands on 27 August 2009. We spoke to the manager, staff that were working and two people who live there. We also observed the way staff listened to people who live there. While we were at the home we looked at some of the records that staff keep. Before we visited the home the manager completed an annual quality assurance assessment for us. The manager used this to tell us about the work staff were doing with people who live in the home. We looked at the last inspection report from 30 August 2007. We received surveys from five people who live in the home and four staff. What the care home does well Peoples needs are thoroughly assessed before they move into the home. This helps to ensure staff know what support people need. Staff have a good understanding of peoples needs. This helps them to provide the support that people need. People are supported to take part in activities they enjoy and keep in contact with family and friends. Staff help people to receive the healthcare they need and to take their medication safely. People who live at the home feel staff treat them well, listen to them and act on what they say. Staff are thoroughly checked before they work in the home. This helps to keep people safe. What has got better from the last inspection The home has been redecorated and the upstairs bathroom has been made more accessible for people. Staff have received more training about peoples specific needs. This helps to ensure they have the right skills to meet peoples needs. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Craig Willis CQC – South East Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 03000 616161 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 set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. There are good systems to assess peoples needs before they move into the home. This helps to reassure people that the home will be able to meet their needs. Evidence: The manager reported in the annual quality assurance assessment that one person has moved into the home since the last inspection. The documents relating to this person were inspected during the visit. The person moved into the home from hospital and a full needs assessment was completed before their discharge. There was detailed information about the persons health, medical conditions, lifestyle including social, spiritual and cultural needs, communication, mobility and food and drink including likes / dislikes and support required. The home had obtained information from the team that provided support for the person before being admitted to hospital. The persons needs have been re-assessed since living at the home following further changes. Hampshire Partnership NHS Foundation Trust has procedures in place for the referral and admission of new people to the home, although these were not inspected during the visit. There is a guide to the services that are available in the home. This is provided in an easy read format, with pictures and symbols to help people understand the information. Four staff who work at the home completed a survey for us. All four said they are always given up to date information about the needs of the people they support and care for. 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. Staff have a good understanding of peoples needs and the support required to meet them, although this isnt always reflected in the care and support plans. People receive good support to make decisions about their lives. Evidence: We looked at the records of three people who live in the home. Each person had a care and support plan that set out how most of their assessed needs should be met. Examples included how people should be supported to make decisions, support to manage health and medical conditions, support that people require to meet their personal care and support to live their chosen lifestyle and participate in social activities. The assessments for one person said they could at times be physically aggressive and try to slap people. Although the issue had been highlighted in the assessments there were no detailed guidelines in place setting out the support that staff should provide in the event of physical aggression. Staff spoken with during the visit did have a good understanding of the persons needs and the action that they should take to support the person and others around them. The manager reported that the support needs for this person had been discussed as part of a team meeting, but she had not had time to develop the guidelines. The manager said she would put these in place urgently. During the visit staff demonstrated a good understanding of peoples needs and the support that they need. We observed staff supporting people to make decisions about their activities for the day. Each care and support plan contained a set of risk assessments. These identified hazards in the activities that people participate in and contained details of the support needed from staff to manage the risks. The risk assessments were evaluated every month to ensure they were still accurate and were reviewed every six months. Four people who Evidence: live in the home completed a survey for us. In answer to the question do staff listen to you and act on what you say, three said always and one did not answer the question. 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 receive good support to take part in a range of activities they enjoy, maintain contact with family and friends and to plan and prepare healthy meals. Evidence: People are supported to take part in a range of activities, including attending social clubs, playing snooker, attending day services and socialising with friends and family. People have been supported to increase the activities they participate in over the last year. One person has been supported to increase their independence, for example going out to a local shop alone. The manager reported that recent staff pressures due to two service users being unwell had impacted on the ability of staff to support other people to go out, but this was now a lot better. People spoken with said they were able to take part in the activities they choose and were happy with the support they received. Five people who live in the home completed a survey for us. In answer to the question can you do what you want to during the day, in the evening and at weekends, three people said yes, one said no and one did not answer. One person is supported to take part in paid employment and one person is supported to attend their place of worship. People are supported to maintain contact with family and friends, with staff providing support to visit family where necessary. People are supported to plan the weekly menu and each person has a cooking day each week when they are supported to prepare the meal. The menu is displayed in pictorial format to make it easier to understand. People are able to choose an alternative meal if they would like. Evidence: 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. Peoples personal and health care is well met by staff who know their needs. There are good systems to safely store and administer peoples medication. Evidence: The care and support plans inspected contained details of the personal care and support people need and how it should be provided. Five people who live in the home completed a survey for us. Four people said staff always treat them well and one said they usually do. Four people said staff always listen to them and act on what they say and one person did not answer the question. People are supported to attend a range of health services including GP, optician, chiropodist and hospital clinics. Details of peoples health appointments are recorded, including any advice from the practitioner. People have been supported to complete a health action plan, which assesses whether they are receiving the health services they need. Medication is stored in peoples bedrooms in a locked cabinet. A record is kept of all medication coming into the home and returned to the pharmacist for disposal. The care and support plans inspected contained details of the support people need to take their medication, including procedures for administering medication that has been prescribed to be taken as required. The medication administration records for the current month were inspected for two people. One persons record had been fully completed. The record for the other person had two gaps where staff had not signed to indicate the medication had been administered. This medication had been removed from the blister pack and a staff member reported that the medication had been given to the person. This error had been picked up by the homes internal systems and was being addressed with the staff member. 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. There are good systems for dealing with complaints and responding to allegations of abuse. This helps to give people confidence that any complaints will be taken seriously and responded to. Evidence: The home has a complaints procedure, which has been provided to everyone who lives there in an accessible format. There is a log of complaints and two have been received in the last year. Both concerned the way two people who live in the home were getting on with each other and both were resolved with the two people involved. Five people who live in the home completed a survey for us, which asked whether they know how to make a complaint. Three people said yes, one said no and one did not answer the question. Two people who live in the home were spoken with during the visit and both said they would speak to the manager if there was something they were not happy about. The home has procedures that cover keeping people safe and how they will respond to allegations of abuse. All staff have completed training in keeping people safe from abuse. Two staff spoken with during the visit demonstrated a good understanding of different types of abuse, signs of possible abuse and the action to take if abuse is witnessed, reported or suspected. There has been one allegation of physical abuse between people who live in the home during the last year. This was reported to the local adult social services team and action has been taken to keep people safe. As reported in the individual needs and choices section of this report staff have a good understanding of the action to take to keep people safe, although there needs to be more information about this in the persons care and support plan. The money held for one person was inspected during the visit. This was kept in a locked cabinet in the persons room and the balance recorded matched the cash held. Records were available of expenditure and bank account transactions. Receipts were kept where money was spend on behalf of the person. The money and bank account records are checked each month by a senior manager in the Trust. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a clean, comfortable and safe environment for people. Evidence: Following the last inspection we made requirements that all part of the home must be reasonably decorated and the first floor bathroom must be adapted to meet peoples specific needs. Both of these requirements have been met. All of the homes communal areas were seen during the visit. The first floor bathroom now has a level access shower that is suitable for the needs of the people that use it. A new kitchen has been fitted and has been made into a kitchen / diner. This was in response to requests from people who live in the home to make the area more accessible and open up the dining area. All areas of the home were well decorated and clean. Five people who live in the home completed a survey for us. All five said the home was always clean and fresh. There is a separate laundry room on the first floor, away from food preparation and storage areas. The home has infection control procedures in place. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are thoroughly checked before they work in the home and receive a thorough induction and very good training. This helps to ensure staff are able to meet peoples individual needs. Evidence: The manager reported that four of the seven permanent staff members have completed the National Vocational Qualification (NVQ) at level 3 and one is currently completing the award. During the visit we spoke with two support workers, one a permanent staff member and one a bank staff. Both demonstrated a good understanding of peoples needs and the support required to meet those needs. The bank staff member spoken with said she received a good induction into the home and specific information about peoples needs and the support required to meet them. The recruitment records of two staff members who have started at the home since our last visit were inspected during this visit. Both records contained evidence that an enhanced Criminal Records Bureau disclosure and two written references were obtained in respect of the person before they started working in the home. The records confirmed that the written references had been verified by telephone. Two of the people who live in the home have participated in the recruitment process for new staff. New staff complete an induction based on the skills for care common induction standards. Following the last inspection we made a requirement that staff must receive specialist training in mental health and dementia care. This requirement has been met. There is a training programme in place, with access to all training courses provided by the Trust. Courses completed include mental health in learning disability, learning disability and dementia, working with dignity, moving and handling, person centred planning, medication, fire safety, safeguarding people from abuse, first aid and sensory loss. The manager has a system in place to track when people are due for refresher training. Staff spoken with said that the training was good. Four staff completed a survey for us and all four said the training was relevant to their role, helps them understand and meet peoples individual needs, helps keep them up to date with new ways of working and Evidence: gives them enough information about health care and medication. 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. There are good management systems in place to assess the quality of the service provided and plan improvements. Evidence: The registered manager has completed the National Vocational Qualification in care at level 4 and the Registered Managers Award. Staff spoken with during the visit were positive about the support they receive from the manager. All four staff who completed a survey for us said they regularly meet with the manager for support and to discuss how they are working. A locality manager visits the home each month to assess the quality of the service provided. Reports of these visits are made and sent to the manager and Responsible Individual within the Trust. The reports contain a list of any actions that are needed and an update of the actions that were required in the previous report. There are regular audits of the service, including a property hazard report, an infection control audit and the annual quality assurance assessment the manager completed for us before the visit. There is an annual survey of people who live in the home. The results of these surveys are collated and used to plan improvements to the home. The action plan resulting from these surveys was not inspected as it had been mislaid at the time of the visit. The notes of a staff meeting in April 2009 contained reference to a review of this action plan and that all the objectives had been achieved. The manager reported that equipment in the home is regularly serviced and maintained to ensure it is safe. We sampled the records for the fire system, gas system and electrical circuits which confirmed the managers report. The home has workplace risk assessments in place that are reviewed annually. These assessments include control measures that people should take to manage any identified risks. Evidence: Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description 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 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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