Care Home: Peel House

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What the care home does well Peel House staff gather a great deal of information about new residents before they decide if they can offer them support. Much of the information about new people is gathered from the community care assessment which accompanies a referral, but this is added to by staff in the home. The assessment includes such information as mobility, specific health needs and family circumstances. Details of any medication support needed is written down and agreed with relatives where a resident is unable to do so. All the assessment information gathered helps to formulate a detailed support plan for them. People who live in Peel House enjoy a wide variety of activities. Daily routines are flexible, although several people attend structured day services, whether day centres or college. Some of the things they do include computer and art therapy, physio, art, cooking and creative music. Some of the residents are very musical, and one person is studying for a Personal Achievement Award, involving communication skills, health and wellbeing, IT, sports and recreation and horticulture. Some of the activities people like to do indoors are puzzles, board games, watching DVDs and TV and listening to music. Some people like to help with food preparation. Other outdoor activities include swimming, bowling, horse riding, and recently people went to the circus in Chippenham. One person likes to ride a tricycle outside. Two residents were planning a short break away soon to a specially equipped hotel, and other had been to Alton Towers for a few nights. We spent time watching staff and listening to them as they worked with service users. All staff were seen to be patient and good humoured, taking time to talk with residents and encourage them to express their thoughts and opinions. When we asked what the home does well, one staff member said: "We always have enough staff to do 1:1 activities with residents on an individual basis", and another said: "We always make sure there are things/activities for people to do. We always seem to have a happy house". Another person said: "We offer a well organised, safe, secure, happy home for the residents. We have a real family atmosphere". When we asked one resident what was good about living in Peel House, he said: "They let me watch videos and watch music on TV. They take me out into town". What has improved since the last inspection? This is Peel House`s first inspection. What the care home could do better: Care plans were of a high standard, and contained lots of information about the residents. There were good risk assessments in place, and there was evidence that these were being reviewed regularly. However, because this was done over a period of time, some staff had not been able to witness that they were aware of the changes. We have recommended that they amend the system to help rectify this. Medication systems were in good order and staff had received training in medication awareness and administration. They have a controlled drugs cupboard. Although they currently don`t need to have controlled drugs for any residents, if they did, they would need the storage they have, and the means of recording the drugs. We have recommended that they should obtain a controlled drugs book so that they can be prepared for any eventuality. We have also suggested that they should seek clear instruction as to the dose and frequency of any medication described "as directed". There had only been one complaint made to the home since it opened, and it related to them not having internet and email facilities. We have recommended that this would be an added bonus if it helped families and friends to be able to communicate with staff. The staff team had done a wide variety of training, including safeguarding people, manual handling and safe use of hoists. They also have kept up to date with fire training and have ensured that each resident has an individual evacuation plan in case of emergency. However, we have recommended that staff have practical, top-up First Aid training, and this should include the use of Cardiopulmonary Resuscitation (CPR). We have also recommended that Albac Mat training is done as soon as possible and an action plan is drawn up for their use along with the personal evacuation plan. When we asked staff what could be done better in Peel House, one person said: "Nothing", and one resident said: "Don`t know". One person said: "Better communication between day and night staff", and another said: "It would be nice to provide a home for more people - we are registered for 8 but only have 4 people staying at the moment". Key inspection report Care homes for adults (18-65 years) Name: Address: Peel House 398 The Spa Melksham Wilts SN12 6QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alyson Fairweather     Date: 0 7 0 5 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 28 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 28 Information about the care home Name of care home: Address: Peel House 398 The Spa Melksham Wilts SN12 6QL 01225702037 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): paulconstable@voyagecare.com Voyage Ltd Name of registered manager (if applicable) Miss Adele Lena Caroline Flegg Type of registration: Number of places registered: care home 8 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 accomodated is 8 The registered person may provide the following category of service only: Care Home only (Code 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 (code LD), Physical Disability (code PD). Date of last inspection Brief description of the care home Peel House is situated on the outskirts of Melksham town centre. The decor is contemporary and allows people to add their own pictures etc. The home has under floor heating throughout, which is controlled by a thermostat in each room. In the communal areas there is a kitchen diner with two adjustable height dining tables, where residents can help prepare meals. There are two lounges and an activity room with adjustable tables. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 8 8 Brief description of the care home There are 8 bedrooms on the ground and first floor, and all bedrooms are suitable for people with a physical disability. Some have ceiling track hoists in place, others have been prepared for this to be added, should it be required. This gives people flexibility over whether they wish to have a ground or first floor bedroom. All bedrooms are 15 sq m. and each bedroom has an en-suite wet room with a toilet and hand basin. There are adjustable beds, and each bedroom is well furnished. There is a lift between the ground and first floors. There is an assisted bath on the first floor and this has two ceiling track hoists. There is a large garden to the rear, with a patio area, and level access into and out of the property. The garden is due to be further developed to include pathways and a further patio. The fees at Peel House range from £1,400 per week to £1,688 per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to Peel House one day in April. We were able to talk with some of the residents, as well as some of the staff and the manager. We received written feedback from all four of the residents who live in Peel House, supported by their keyworkers, and from nine staff members. We also looked at various files and documents, including care plans, risk assessments, medication procedures, health and safety procedures, staff training files, and the staff recruitment procedures. 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. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care plans were of a high standard, and contained lots of information about the residents. There were good risk assessments in place, and there was evidence that these were being reviewed regularly. However, because this was done over a period of time, some staff had not been able to witness that they were aware of the changes. We have recommended that they amend the system to help rectify this. Medication systems were in good order and staff had received training in medication awareness and administration. They have a controlled drugs cupboard. Although they Care Homes for Adults (18-65 years) Page 7 of 28 currently dont need to have controlled drugs for any residents, if they did, they would need the storage they have, and the means of recording the drugs. We have recommended that they should obtain a controlled drugs book so that they can be prepared for any eventuality. We have also suggested that they should seek clear instruction as to the dose and frequency of any medication described as directed. There had only been one complaint made to the home since it opened, and it related to them not having internet and email facilities. We have recommended that this would be an added bonus if it helped families and friends to be able to communicate with staff. The staff team had done a wide variety of training, including safeguarding people, manual handling and safe use of hoists. They also have kept up to date with fire training and have ensured that each resident has an individual evacuation plan in case of emergency. However, we have recommended that staff have practical, top-up First Aid training, and this should include the use of Cardiopulmonary Resuscitation (CPR). We have also recommended that Albac Mat training is done as soon as possible and an action plan is drawn up for their use along with the personal evacuation plan. When we asked staff what could be done better in Peel House, one person said: Nothing, and one resident said: Dont know. One person said: Better communication between day and night staff, and another said: It would be nice to provide a home for more people - we are registered for 8 but only have 4 people staying at the moment. 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 28 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 28 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. Prospective residents and families are given information leaflets so that they can choose whether or not they wish to use the service. Residents have their individual needs assessed before they arrive, so that staff know how best to support them. Evidence: The home has a Statement of Purpose and Service User Guide, which give an overview of the service to be provided. This is given to every resident and or their family, and also gives details of the organisations complaints procedure. There is a possibility of offering respite care to some people, and this should be recorded in the Statement of Purpose if this goes ahead. One family member said: communication levels are extremely high. I have no problems in obtaining any help or information. Referrals come from the prospective residents Care Manager who provide the service with a recently completed Community Care Assessment and any other relevant information, in order to initially identify whether the service is appropriate for and able to meet the needs of the individual. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Following this, if it initially appears that they are able to offer a service, a visit will be arranged for the person, along with their Care Manager and/or any other appropriate carer, family member, friend or advocate. If successful, another visit will be arranged in order that the individual can join existing service users for a meal and to spend time socialising and interacting with current residents and members of the staff team. This process is very flexible and can be tailored to meet the needs of the individual. Three of the current residents came from another placement, and staff from both homes spent time working out the best way to support them in their new home. All residents have a residency contract from Voyage. Care Homes for Adults (18-65 years) Page 11 of 28 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. Care plans reflect the needs and personal goals of residents, and they are assisted to make decisions about their own lives wherever possible. They are supported to take risks where appropriate, and encouraged to be as independent as possible, whilst making sure they are safe. Evidence: Peoples support plans include details of any personal care needs, medical and physical health, mental health needs, mobility and communication skills. They also highlight their likes and dislikes, and what activities they like to take part in. Staff record residents activities well as their general wellbeing on a daily basis. Manual handling assessments and behavioural guidelines were in place for those service users who need them. Peoples daily routines were also recorded. We looked at care plans for several resident and saw that clear records were being kept, and that these were being reviewed regularly. Staff were asked to sign to say that they had read the care plan reviews. However, not all of them had been signed, Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: and the manager explained that this was because they were done bit by bit, and staff signed each time. Each care plan has a number of sections, and this means that it can take a long time to review them and to sign them. We discussed the fact that if one whole care plan was reviewed it might be easier to keep track of who had read and signed it. These could be broken up into alternate months, so that not everybodys care plan was reviewed at the same time. The manager has agreed to develop the current system so that this can be done. One resident we spoke to likes to be called different names every day and staff cheerfully accommodated this. When we asked care staff if they were given up to date information about the needs of the people they support, six people said: Always and three people said: Usually. Currently, no resident is able to take charge of their own money. Some have parents and others have independent appointees. Some money is held in the safe for various sundries, and this is checked several times a day. Staff keep receipts for everything they help people to buy or pay for. There is no independent advocacy involvement in Peel House at the moment, although the manager was clear that this would immediately be put in place if needed. People do not have restrictions placed on them, although certain health and safety issues have to be taken into account. For example, the front door, which leads onto the street, is locked with a key pad, but the back door, which leads out to the garden and patio is kept unlocked. Where there are restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. The three residents who wrote to us, with staff support, said they could always or usually make their own decisions about what they want to do. Risk assessments had been done for some service users and these included areas such as mobility, use of bed rails and travelling. There were also risk assessments on file relating to peoples epilepsy and diabetes. Ways of minimising risks were identified, and this was reviewed frequently. Staff place great emphasis on encouraging service users to be as independent as possible, while trying to minimise any risk to their safety. Care Homes for Adults (18-65 years) Page 13 of 28 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. Social and leisure activities are varied and tailored to individual need, and people use facilities offered by the local community. Residents can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. They are offered a healthy diet, with their preferences taken into account. Evidence: People who live in Peel House enjoy a wide variety of activities. Daily routines are flexible, although several people attend structured day services, whether day centres or college. Some of the things they do include computer and art therapy, physio, art, cooking and creative music. Some of the residents are very musical, and one person is studying for a Personal Achievement Award, involving communication skills, health and wellbeing, IT, sports and recreation and horticulture. Some of the activities people like to do indoors are puzzles, board games, watching Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: DVDs and TV and listening to music. Some people like to help with food preparation. Other outdoor activities include swimming, bowling, horse riding, and recently people went to the circus in Chippenham. One person likes to ride a tricycle outside. Two residents were planning a short break away soon to a specially equipped hotel, and other had been to Alton Towers for a few nights. When we spoke to staff about activities, one person said: We always have enough staff to do 1:1 activities with residents on an individual basis, and another said: We always make sure there are things/activities for people to do. We always seem to have a happy house. The residents who wrote to us with support, all said that they can do whatever they want to do during the day, in the evenings and at weekends. Friendships both inside and outside the home are encouraged, and staff support links between residents and their family and friends, although the frequency of contact varies depending on the individual circumstances. Visits out are supported, and people have spent some time at their family home. One family had stayed overnight to show staff how to deal with their relatives condition. People are free to visit friends outside the house at any time, and can entertain and choose to see who they like either in the privacy of their own bedrooms, outside in the garden or in the communal areas available. Residents can choose when to be alone or in company, and when not to join in an activity. The menu supplied in the home is varied and nutritious, and is centred round the likes of the people staying in the home on a daily basis. The kitchen uses what is called a healthy eating plate, and this shows staff who cook the residents meals how much a portion of protein, vegetable and carbohydrate should be. There was a good supply of fresh fruit and vegetables in the home, and juices and yoghurts are also available. Lunch on the day we visited was either wraps or toasted sandwiches, and supper was cottage pie with vegetables. Staff have records of the food likes and dislikes of all service users, and of any feeding support necessary. The dining room is large, with good lighting and has paintings on the wall, making it a comfortable, pleasant environment for residents to eat in. Staff also eat alongside the residents. People with diabetes have their diets catered for and any resident who needs percutaneous endoscopic gastrostomy feeding (PEG feeding) has a care plan and risk assessment in place. Care Homes for Adults (18-65 years) Page 15 of 28 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. Residents personal support needs are recorded in care plans so that they can receive this support in the way they wish, and their physical and emotional health needs are met. They are protected by the homes medication policies, procedures and practices. Evidence: All the service users at Peel House have assistance with personal care. This is tailored individually, depending on their abilities, and any safety concerns. Attention is given to ensuring that residents maintain a positive image at all times. Apart from Learning Disabilities, a number of residents have other physical conditions which need monitoring. There were good records of communication with GPs, Occupational Therapists (OT), orthotics, consultants, diabetes clinics, and the local Community Team for People with Learning Disabilities (CTPLD). Appointments with health professionals were well documented, and gave details of any changes in peoples treatment. The manager has provided lots of information about different conditions which might help staff to understand the residents more. Other residents have epilepsy, and use special monitors through the night to make sure they are safe. There are two waking night staff on duty. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: We saw one instance where someone had developed a mild pressure sore. The home had instantly reacted to this, had taken advice, and was using appropriate mattresses and cushions. A care plan and risk assessment had been put in place. None of the residents are self-medicating. Staff are involved in storage, administration and recording of any prescribed drugs. They have almost all had training, and this includes specific instruction in the specific technique for administration of a drug to help manage epilepsy. We watched one staff member deal with peoples medication in a safe manner. Some people have medication prescribed for occasional use, and protocols are in place for when and why they might be needed. However, some of these have arrived from the chemist marked: As directed. This practice is not encouraged, and the manager should ask the prescribing doctor to specify how much and when the medication is to be given. The storage and recording of medicines in Peel House is good. Medication is kept in a designated room and is kept in a locked cupboard in this room. Medication support is recorded on a Medication Administration Record (MAR) and when checked this was seen to be accurate. Records of medicines received, administered and disposed of were examined, and seen to be in order. A check of the stock in the medication cupboard showed all was in order. The home has a controlled drugs cupboard, but do not have a controlled drugs book. At the moment, there are no residents living at Peel House who need controlled drugs, but it is recommended that they get one, so that they can be prepared for any eventuality. Care Homes for Adults (18-65 years) Page 17 of 28 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. Residents and their families have their views listened to and acted on. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. Evidence: The home has a complaints procedure in place, and this is given to residents and their families along with the service user guide. They had received several compliments, such as: We are very pleased with how happy people are living here, and another said: I am impressed by how you keep our relatives condition under control. They had received one complaint, which had which had been dealt with, but had been unable to be resolved. This complaint had come from the relative of one of the residents, who was used to dealing with correspondence electronically. They said: It seems incredible that Peel House is still not connected to the internet. It is an extremely essential form of communication for all of us, and especially when complex medical information has to be shared. Email is used as the main form of communication in the day resources my relative attends, and vital information cant be communicated. Also, messages dont always get passed on accurately. It would avoid any dispute as to whether a message has been received or not. The manager was fully aware of how complaints were dealt with, and when she needed to seek advice or support. She did not have the authority to have the internet Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: and email set up, but was keen for this form of communication to be available. It is recommended that the providers give urgent consideration to having the internet and email facilities in the home. All nine staff who wrote to us said that they knew what to do if someone had concerns about the home. The home operates in accordance with local multi-agency arrangements for adult protection, and a copy of the relevant procedure is kept in the home. A whistle blowing policy is in place, and the home has appropriate staff conduct and disciplinary procedures in place should they need to use them. All staff are aware of the No Secrets guidance and all have had safeguarding training. The manager and the deputy manager are having training in use of the Wiltshire and Swindon Safeguarding Procedures, and it is planned to cascade this to all staff. Care Homes for Adults (18-65 years) Page 19 of 28 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. Residents live in a homely, comfortable and safe environment which is clean and hygienic. Evidence: Peel House is situated on the outskirts of Melksham town centre. The decor is contemporary and allows people to add their own pictures etc. The home has under floor heating throughout, which is controlled by a thermostat in each room. In the communal areas there is a kitchen/diner with two adjustable-height dining tables, where residents can help prepare meals. There are two lounges and an activity room with adjustable tables. There are 8 bedrooms on the ground and first floor, and all bedrooms are suitable for people with a physical disability. Some have ceiling track hoists in place, others have been prepared for this to be added, should it be required. This gives people flexibility over whether they wish to have a ground or first floor bedroom. All bedrooms are 15 sq m. and each bedroom has an en-suite wet room with a toilet and hand basin. There are adjustable beds, and each well furnished. There is a lift between the ground and first floors. There is an assisted bath on the first floor and this has two ceiling track hoists. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Appropriate equipment has been obtained to help meet the needs of residents with impaired health and mobility, such as specialist beds. This has been done with support and advice from the relevant professionals, who have also given instruction in their appropriate usage. There is a large garden to the rear, with a patio area, and level access into and out of the property. The garden is due to be further developed to include pathways and a further patio. Staff told us: Our home is always kept tidy and organised, and that they: Provide a homely, friendly environment for residents. Someone else said: We offer a well organised, safe, secure, happy home for the residents, with a real family atmosphere. Records are kept of cleaning schedules, and audited as part of the overall quality assurance process. Laundry facilities are situated away from those parts of the building regularly accessed by service users. These have good wall and floor coverings, which means that these areas can be kept hygienically clean, minimising any infection risks. Staff have also had infection control training. Care Homes for Adults (18-65 years) Page 21 of 28 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. Residents are supported by staff who have achieved at least NVQ Level 2, who have had appropriate training, and have regular supervision with their line manager. They are protected by the homes recruitment policy and practices Evidence: New staff are overseen by a senior carer during their initial induction and orientation. After a couple of months, once they have settled in, they begin working on a nationally recognised set of induction standards: the Learning Disability Qualification (LDQ). Nine staff members have achieved NVQ Level 2 and NVQ Level 3. We watched and listened as staff members spoke to the service users who were at home. They treated them politely and listened to them when they spoke. They asked service users for their opinion about everyday matters, and spent time preparing them for what was happening later. When asked by us if staff treated them well, one resident told us that they were happy living in Peel House, and that staff were good to them. The home operates an Employee of the Month scheme, and colleagues are encouraged to nominate each other and highlight good practice. Staff training during the last year has included manual handling, first aid, medication awareness and administration, fire instruction, non-violent crisis intervention, food Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: hygiene, health and safety and hoist training. Their first aid training was done as on line, and did not include the use of Cardiopulmonary Resuscitation (CPR). It is recommended that this is topped up with practical training, including CPR There has been some specialist input for staff, and some of them have done training in how to manage percutaneous endoscopic gastrostomy feeding (PEG feeding), and administration of medication specifically for helping with seizures and tissue viability. Staff have told us that they are offered regular training, and all nine people who wrote to us said they were always given training which is relevant to their role, helps them understand the needs of service users, and keeps them up to date with new ways of working. One person said: We have good training, and another said: We have a very friendly, helpful staff team. Someone else said: Staff are enthusiastic and willing to learn new skills. There is a checklist for all stages of recruitment, selection, and joining the organisation. This is closely linked to the homes quality assurance system. Three sets of staff files were viewed. These showed that all required checks are carried out, at the appropriate times. New staff do not commence working until satisfactory references and CRB checks have been obtained. Residents have informal involvement in the recruitment and selection of staff, as candidates visit the home. All new staff are subject to an initial probationary period. This may be extended, if it is felt that an employee has not yet demonstrated the necessary competence or conduct. Additional supervision arrangements are then put in place. Staff supervision occurs at regular intervals, approximately six times per year. The manager described how she does all supervisions at the moment, but that the deputy manager was training so that they could support the senior workers and the seniors would then supervise the care staff. The manager would still be responsible for annual appraisals. Care Homes for Adults (18-65 years) Page 23 of 28 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. The registered manager is suitably qualified, competent and experienced, so that residents benefit from a well run home. Quality assurance measures underpin service developments, and include actions based on knowledge of the residents, and the views of relatives and other professionals. Residents health and safety are protected by the systems in place. Evidence: The day to day management of House is carried out by Ms Adele Flegg. Ms Flegg is a qualified nurse RMN 1 and completed her Learning Disabilities nurse training in 1992. She gained her Registered Managers Award (RMA) in 2005. The deputy manager has applied for the certificate in Leadership and Development. One staff member said to us: The manager and deputy are always ready to listen if you have a concern or an enquiry, and another said: We have a very approachable management team. Theyre always available if needed and we can ask them anything. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The parent organisation, Voyage, conducts regular quality assurance audits internally, and a senior manager visits the home every month to meet with service users and check on various records. A quality assurance questionnaire has been devised by the home for residents and their families. They were asked how they felt the first few months of the home opening had been managed, and if there were any suggestions about how things could improve. It is planned to extend this more fully so that all residents and their families have a chance to give their opinions on the home. There were some good health and safety records in place. The fridge and freezer temperatures are recorded daily and there are various weekly, monthly and annual checks done to make sure the home is safe. The homes hoists, tracking systems and fire equipment are serviced on a regular contractual basis. A recent fire safety audit had been done, and there was a letter on file from the fire authority saying they had fully met all their checks. The homes fire risk assessment was up to date, and the fire training book showed that all staff had fire training. A recent fire drill had taken place, and had been completed successfully. Each resident has a personal evacuation plan in the event of any emergency. This involves the use of the Albac Mat. This is an instant evacuation mat for the fast and safe removal of individuals unable to remove themselves from emergency situations. It is a self-contained unit that rolls out to the size and shape of a sleeping bag and can be fitted to a patient in seconds, enabling their evacuation in minutes. Whilst staff have some knowledge of how they work, they have not had any training in their use for specific individuals. It is recommended that this training is done as soon as possible and an action plan is drawn up for their use, along with the personal evacuation plan. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 7 The manager should consider introducing a simpler system of reviewing and signing peoples care plans, so that the whole document can be done, instead of some sections. This would make it easier for staff to know they were working with the most up to date care plans. The home should have a controlled drugs book in order that they can deal with any urgent need for them to store these drugs. The manager should ask the prescribing doctor to specify how much and when as directed medication is to be given. The providers should give serious consideration to having internet and email facilities in the home. The manager should ensure that staff have practical, topup First Aid training, and this should include the use of Cardiopulmonary Resuscitation (CPR). The manager should ensure that Albac Mat training is done as soon as possible and an action plan is drawn up for their use along with the personal evacuation plan. 2 20 3 20 4 5 22 35 6 42 Care Homes for Adults (18-65 years) Page 27 of 28 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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