Care Home: Peverell

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What the care home does well The service clearly demonstrated a very person centred approach to the support provided, with the wishes, likes and dislikes of all three residents placed at the fore of any decisions made. The residents are well known in their locality, making use of local facilities, and on the day of our visit, had lunch in the local pub, a regular event. We discussed this with one of the residents who clearly enjoyed his lunch, and told us of other things he enjoys, which staff help him to do. On the day we were there, staff were observed during their everyday support, and spoke to the residents very appropriately. The residents are encouraged to assist with household tasks, one told us he enjoys cutting the lawns. Staff have all received suitable training in the past year, helping them offer a high level of support to the people living in the home. What has improved since the last inspection? Our last inspection took place a few days after the home changed ownership, and since this time a number of changes have been made, with new policies and procedures, care plans an other documentation introduced. Many parts of the home have been redecorated, and new flooring and carpets provided, and some of the household equipment renewed. Staff have received more training than previously, which helps in their everyday work. What the care home could do better: Plans to continue refurbishment were discussed, as were management arrangements in the home. Since the new owners acquired the home, a number of changes in management have taken place, and this now needs to be resolved, to provide a consistent level of management support to staff and residents. It was also suggested that the service look at some of the more structured daytime activities that may be available in the area. One of the residents is keen t o take a cookery course, and this should be encouraged. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Peverell Station Road Foulsham Dereham Norfolk NR20 5RE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Buttery     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Peverell Station Road Foulsham Dereham Norfolk NR20 5RE 01362683581 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) : Devaglade Limited care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is 3 The registered person may provide the following categories of service: 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 Date of last inspection Brief description of the care home Peverell is a care home providing accommodation and care for three younger adults with a learning disability in a domestic homely environment. It is owned by Devaglade Limited who oversee the general management with additional management responsibility given to staff employed within the home. Peverell is a detached house located in the centre of the village of Foulsham. The surrounding countryside is rural in character. The home is close to all local amenities, including public transport, although there is a vehicle that is used to transport the service users to a variety of activities and excursions. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home Each service user has their own bedroom, which they can personalise. The communal facilities include a lounge, conservatory and bath/shower room. The kitchen/dining rooms is domestic in style. There is a laundry room and staff office. The home is staffed 24 hours a day. Residents have access to activities locally and further afield. There is a small garden area at the rear of the building and parking to the front. Fees charged by the servie range betweeen 1000 and 1600 pounds per week, according to assessed individual need. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit, during which we discussed the service provided with the current management of the home, and looked at a number of records, including resident and staff records. We also spoke at length with one of the three people who live in the home, and their views are included within the report. Because of management difficulties, the home is currently being overseen by the manager of another service owned by the provider, with support from the regional manager. Care Homes for Adults (18-65 years) Page 6 of 27 Peverell is a detached property in the Norfolk village of Foulsham, close to local facilities include shops and a Pub, and the service has a vehicle suited to the needs of the people living there which is used to access local amenities. The three residents have individual rooms, decorated in a style of their choosing, and communal areas include a lounge, kitchen, utility area and conservatory as well as a bath/shower room. Outside is a small garden area with patio and seating, which is well used by the residents. 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 set out 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 Care Homes for Adults (18-65 years) Page 8 of 27 7535. Care Homes for Adults (18-65 years) Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that a full assessment would be undertaken before anyone new moved to the home, although this is unlikely at the present time. Evidence: This is a small home for people with learning difficulties, and all three have lived in the home for a number of years. There is no immediate likelihood that this will change, although the provider does have procedures in place to ensure that, in the event of a new admission, full assessments would be undertaken before anyone moved in, and the compatibility of the new group considered, to ensure that any change did not impact on the others living in the home. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans are in place that show how identified needs are supported, in a manner suited to the individual person. Evidence: During our inspection visit, we discussed the individual care plans with the person currently overseeing day to day management of the home, and with one of the residents of the home. In addition, we looked at the individual plans for all three of the residents of this home. These showed that the individuals had been part of the planning process and signed the plans. The plans showed how the identified needs were met, how individuals liked their support given, and detailed many of the likes and dislikes of the person they related to. Evidence was seen on the plans that we examined that they are reviewed on a regular Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: basis, normally three monthly, and the plans also included risk assessments and management guidelines in the case of difficult behaviour, and communication guidance. During our visit, staff were seen to be very attentive and responsive to the individual residents, and the daily notes enclosed with the plans showed how they try to include the resident in day to day decisions. Since the last inspection, risk assessments have all been reviewed to ensure they offer sensible and practical guidance in supporting everyday activity. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are able to take part in a range of activities, which they enjoy, both on their own and with fellow residents Evidence: When we arrived to carry out this inspection, all three residents were out, which appears to be a regular occurrence. The previous weekend, they had all gone to the coast for a picnic, and the previous week been out on several occasions, and records of these trips out were seen. The service is small, and clearly run for the benefit of the three residents, with a range of activities and pursuits. As well as those already described, the residents are able to go shopping (a trip was planned for later in the week to do some shopping and have lunch in Norwich, coinciding with the birthday of one resident), swimming, horseriding, Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: local club and society events and trips out to local attractions. The residents are all able to go on an annual holiday, visit nature reserves and garden centres, and a vehicle is always available to help them get to the events. In addition, a beautician visits the two ladies who live in the home. The residents also help with everyday chores around the home, and assist with cooking, and one of the residents told the inspector how he is hoping to go onto a course locally to learn to cook more. This was confirmed by the management of the service. During our visit, we discussed whether more structured activities may also be of benefit to the people living in the home, and this is something that the service will look at, and discuss with the funding bodies. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support is provided with appropriate professional support, ensuring all identified health and personal care needs are met, and in a way suited to the individual. Evidence: All of the residents need assistance with their health and personal care needs, and receive support in line with their needs and wishes, which are clearly shown in the individual care plan documentation. Some behavioural difficulties have been identified, and the individual plans we looked at clearly show how these behaviours can be managed. Suitable equipment, aids and adaptations are in place to ensure that the people living in the home can lead a safe lifestyle, including grab rails in the bathroom an special crockery and cutlery. The home receives good support from local health professionals, including their GP, continence advisers, epilepsy specialists and nursing staff. They are all registered with a GP practice about 5 miles away, and the pharmacy forms part of the practice, Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: supplying medication and training. Senior staff are responsible for administering medication, and have all received appropriate training. The residents receive dental treatment as required at the hospital in Norwich, and opticians visit the home annually to carry out eye tests. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to ensure that any concerns, complaints or allegations are appropriately dealt with, and that people living in the home are aware of how to make concerns known. Evidence: Since the new providers took over the service new procedures have been introduced, and people living in the home are aware of how they should make concerns known. During our visit, we spoke to one of the residents, who clearly knew who he should speak with if he had any concerns. Procedures are in place to ensure that any possible safeguarding matters are reported and appropriate action taken, but since our last visit, there have been no issues of concern. The AQAA indicated that no complaints had been received by the service. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides people living in the home with a safe, clean and homely environment, well furnished and with aid and adaptations needed by the people living there. Evidence: The service is based in a 3 bedroom detached house close to the centre of the Norfolk village of Foulsham. The property offers good communal space with a lounge, dining room kitchen and conservatory as well as office space/sleep in facilities. Upstairs are three good sized bedrooms and a shared bathrooms. All the rooms occupied by the residents showed how the personal wishes of the person had been taken into account, and were well equipped. The home has a small garden, but this is well maintained, and has garden furniture, which has recently been purchased and a barbecue, and this is used during the summer. Since our last visit, some of the flooring downstairs has been replaced, the washing machine and tumble drier renewed, new garden furniture purchased and much of the home has been redecorated. Care Homes for Adults (18-65 years) Page 19 of 27 Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are followed which ensure residents are supported by a staff team who are well trained, and have met appropriate recruitment checks Evidence: During our visit, we looked at staffing in the home, and at the records held by the service. Although the service was taken over shortly before our last visit, they have retained a core staff , who are well known to the three residents. There are normally three staff on duty on weekdays, but only two at weekends, which can restrict the availability of individual activities at weekends, although they often all go out together. This is something the service may wish to consider, to further enhance the lives of the residents. Staff records all indicated that the recruitment procedures are being followed, and that the required records are held by the service, and training records showed a range of training had been provided in the last year, both mandatory and specific to the needs of the three people living in the home. During the visit, we observed the manner in which staff spoke to the residents, and Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: were able to talk at length to one of the residents, who was very happy with the support staff provided. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures ensure that people living and working in the home are not at risk, and the views of the residents taken into account in all day to day decisions. Evidence: Since our last inspection, the management of the home has been undertaken by two managers, neither of whom have registered with the commission, and it is likely a further management change will take place. Although the service is being well managed by the area manager, and the manager from another home nearby owned by the company, it is important that a permanent manager is in post, and registered with the commission as soon as possible, which will ensure the continuity of support to the residents. Clearly a lot of work has been done by the management team since our last visit, with the requirements that were made all now met, and policies and procedures updated, along with improvements to the building. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The people living in the home all appeared very happy with the support they receive, and were clearly involved in all areas of the lives, and helping with day to day task in the house and garden. Health and safety procedures are in place to ensure that people living and working in the home can do so safely, and staff training and supervision are all in place. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 Management arrangements 31/08/2009 must be resolved, and an appliaction for the manager of the home to be registered with the Care quality commission To ensure that the resients receive a consistent support. 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 33 The service should consider whether more staff can be available at weekends to add to the variety of activities that can be offered to the people living in the home. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - 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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