Care Home: Peveril

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What the care home does well We found that people who are considering moving into the home have their needs assessed before a decision is made. People are supported to make decisions in their daily lives such as what to eat for breakfast and what activities to do. People who use the service are supported to participate in activities which interest them and maintain links in the community and with family and friends. People who use the service are supported to make healthy choices when choosing meals to eat. People receive support the way they prefer and are able to express their wishes and are supported to maintain their physical and emotional wellbeing. There is a clear system in place for ensuring that medication is managed correctly. people tell us their views and worries are listened to and acted upon. People tell us they like where they live and that it is homely. Infection control is taken seriously and the systems are in place to keep the home clean. There is a recruitment system in place which protects the people who use the service. Staff receive the training and support they need to do the job well. the home is managed by people who understand the needs and wishes of the people who live there. There is a system in place to ensure that people are listened to and their views form part of the development of the service. What has improved since the last inspection? At the last key inspection in June 207 there were no requirements and no recommendations. At the random inspection in December 2008 there were two recommendations. All staff working in the home have been booked on a training course which will enable them to deal with situations which could require physical restraint. Not all incidents occurring in the home were reported to the commission, we have found that the home is now sending all incidents to the commission according to regulation 37. What the care home could do better: At the end of this key inspection there are no requirements and three recommendations. It is important that people who use the service are involved in the care planning and that the service is able to evidence this. To ensure that people who use the service are safe at all times, risk assessments should be clear on how people are to be supported when taking risks. When supporting people to make meal choices it is important that recording is clear so that any concerns can be picked up quickly and advice sought. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Peveril Springbrook Close Harmans Cross Wareham Dorset BH20 5HS     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: Tracey Cockburn     Date: 1 1 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 26 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 26 Information about the care home Name of care home: Address: Peveril Springbrook Close Harmans Cross Wareham Dorset BH20 5HS 01929427996 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) : penrose@penrose.f2S.com Penrose Residential 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 category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) Date of last inspection Brief description of the care home Peveril is a family run residential home in a small rural village. It is registered to provide care, accommodation and support to 3 people who have a learning disability. The accommodation is over two floors with one en-suite bedroom being on the ground floor. The upstairs room has a bathroom on the same level. The 3rd bedroom has ensuite facilities. There is a kitchen area with a small dining table and a large lounge with a dining area. There are gardens to the rear of the property, which are accessible and provide opportunity for outside activities. It is also in easy access to the town of Swanage and Corfe where there are a range of community facilities The weekly fees range from 680 pounds to 1200 pounds. For further information on Care Homes for Adults (18-65 years) Page 4 of 26 0 3 1 2 2 0 0 8 Brief description of the care home fees and contracts information can be found at the Office of Fair Trading website: www.oft.gov.uk Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 visit the home without telling them we were coming. The visit was part of a key inspection to review how well the home was doing in meeting the key standards of the national minimum standards. We want to know how people are supported to live the life they want to. We spoke to three people who use the service, we spoke to staff who provide care and support and we spoke to the people who own and manage the service. We sent survey forms out as part of the planning process, we had two survey forms back from health care professionals, two back from staff who work in the service and two back from people who use the service. We looked at information the service sent to us such as notifications of incidents and the annual quality assurance assessment. During the site visit we spoke to people who use the service, we also looked at Care Homes for Adults (18-65 years) Page 6 of 26 documents relating to their care such as care plans and risk assessments. What the care home does well: What has improved since the last inspection? What they could do better: At the end of this key inspection there are no requirements and three recommendations. It is important that people who use the service are involved in the care planning and that the service is able to evidence this. To ensure that people who use the service are safe at all times, risk assessments should be clear on how people are to be supported when taking risks. When supporting people to make meal choices it is important that recording is clear so that any concerns can be picked up quickly and advice sought. Care Homes for Adults (18-65 years) Page 8 of 26 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 7535. Care Homes for Adults (18-65 years) Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a system in place to ensure peoples needs are assessed before they move into the home. Evidence: One person has been admitted to the service since the last key inspection and we chose to look at this persons file, to find out their experience of moving into the home. The annual quality assurance assessment says: We have admitted one new resident in the last year. We did various introductory visits with two Peveril visits. Decision made with social worker, old home manager and family member not to have over night stay, but to move in with all his own personal furniture and belongings ready for arrival. There is a full care management assessment and care plan on the persons file as well as a pre admission assessment completed by the manager of the home. The service received an updated care plan from the funding authority prior to the person moving in. Care Homes for Adults (18-65 years) Page 11 of 26 Care Homes for Adults (18-65 years) Page 12 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involved in the planning and support they receive. Some changes to the documentation need to be made to evidence this clearly. Evidence: Three people are currently living in the service, we spoke to all three people and looked at one persons care plan, this has been completed following a person centred approach. We looked at one persons care file. The file contains photographs of the things the person likes to do such as eating out, visiting Bournemouth. The care plan was in place as well as pre admission assessment, both detailed the personal and health care needs as well as the emotional needs of the person and how they prefer to be supported. The manager told us that the transition took only 2 weeks which they felt was a very short time. A review took place about six weeks after the person moved in to discuss how they Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: had settled into the home. We found there are risk assessments in place for the person covering water temperature when having a bath, as well as wet shaving, skin infection and banging his head. The risk assessment did not contain information on the correct bath temperature for the person. It had been highlighted in the care plan that one of the things the person is not capable of is determining water temperature. The manager told us that the person was involved with the care plan as well as other people important in their life who knows them well, we could not see any other evidence that the person was involved as the document was not signed by their representative. We spoke to one person who told us that they were asked about the content of their care plan and they told us that the staff write down information about what I like and dislike. Care Homes for Adults (18-65 years) Page 14 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make choices in their everyday life and supported to develop their life skills. Evidence: We spoke to two people who use the service about the activities they participate in. At the time of the site visit two people were in their vegetable garden being supported by a member of staff. The manager of the home told us that a Thursday is when two of the people living in the home do not attend day services and participate in activities from home. One person was going clothes shopping. One person told us that they are able to participate in a variety of activities and visit friends. One person was able to tell us how much he enjoyed working in the vegetable garden. The staff keep a record of the activities people participate in. Two people attend day services four days a week. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Work has been done to develop the menus and given the people living in the home more choice at meal time. The menu now has photographs of meals available each day. The staff also keep a record of what people eat. In discussion with the manager, she has had to speak to staff about leaving gaps in the recording which could lead someone to consider that people where not eating properly. One example was a gap for one person, which said that they had not eaten an evening meal. It did not give any other information such as what they ate at lunch time or whether they had supper later on. The manager also told us about another person and the reduced protein diet he is on which can alleviate the symptoms of his medical condition. The manager told us about the changes made to the persons diet such as the introduction of rice milk and how this change to his diet has made an impact on his anxiety. The manager was able to evidence that this had been done with the support of a dietitian and as part of a multi disciplinary approach. We received a survey back from a health care professional which said under heading what do you feel the care service does well: Liaise in a multidisciplinary way The annual quality assurance assessment submitted by the home says: We now provide a suggestion menu so residents can have more choice over what they eat. We also allocate a day a week when each resident can choose and help to cook meal of own choice. Meal times are flexible. At breakfast time people who live in the service are encouraged to make their own breakfast with support. One person who lives at Peverill said they help with the shopping and decide what to prepare and eat together. The menu see was well balanced with salads and fresh vegetables as part of each meal. Records are kept of food temperatures each day at the point they are served. Care Homes for Adults (18-65 years) Page 16 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Evidence: The care plan gave clear evidence of health care appointments being made for one person. There was also evidence that advice had been sought about the diet of one person who has a condition in which the symptoms can be alleviated through reduced protein diet. A survey returned from a health care professional stated: Recognise deterioration in client and seek appropriate health advice The health care professional also wrote that: will seek advise from professionals when the need exceeds the expertise The care file for one person contained information on when he last had a review from his GP and the expectation that this is done every 6 months. The personal profile for one person was very clear on how he liked and preferred to be supported and what things triggered anxiety. The person centred plan also says the things which are essential to the person such as I like baths not showers, music and being complimented about clothes . It also says what he doesnt like: fuss, sudden Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: movement and sandwiches. There was clear recording of when people who use the service have health care appointments such as the Doctor, dentist and specialist community nurse. We looked at medication for the home, which is stored in a locked metal cupboard. The home use a monitored dosage system, they have recently changed to a different pharmacy and tell us it is working well. All staff who handle medication have received training. Care Homes for Adults (18-65 years) Page 18 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure. Evidence: There has been one safeguarding investigation since the last key inspection in 2007. The allegation was fully investigated. Staff who work in the home complete safeguarding training and complete a report following any incident in the home. There is a complaints policy, which is detailed, in pictorial format as well as words to support access. There had been no complaints since the last inspection. Care Homes for Adults (18-65 years) Page 19 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a safe, well maintained and comfortable environment. Evidence: We toured the building and one person was happy to show us their room and tell us they clean it themselves with a bit of support. Improvements to the home including replacing carpets, improving infection control practice. One person was happy to show us their room and they explained that they want a tree for their room, an artificial one, they have cleared a space for it and the providers are taking her to IKEA to buy one. The furnishings are modern and comfortable. The home meets the requirements of the local fire service and environmental health. The home takes responsibility for infection control seriously and has a detailed self- assessment tool NHS essential step, which it uses. Care Homes for Adults (18-65 years) Page 20 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: Training places have been sourced for breakaway training which was a recommendation following a random inspection in December 2008. There have been no new staff recruited since the last inspection. At the last key inspection in June 2007 recruitment was reviewed in detail and the procedure used by the home was robust. The annual quality assurance assessment told us that there are six permanent staff employed in the home and four currently have national vocational qualifications at level two or above and two are studying to wards the award at level two. Two survey forms were returned from staff who told us: we have very goo dcommuniaction with our manager about people living in the service Induction covered everything we needed to know Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure the home is managed in a consistent way to meet the needs and wishes of the people living there. Evidence: Mr and Mrs Wills are in day to day control of the home. They have both successfully completed the registered managers award. The home has a quality assurance system in place. They consult with people who live in the service and other people such as family and health and social care professionals. An audit of all incidents is done each month following advice from the local contract monitoring team. The manager of the service has completed a course on the deprivation of liberty safeguards. Breakaway training has been organised for staff on the 15th 16th and 17th of June 2009. This was a requirement at the random inspection in December 2008. The manager sent out 12 stakeholder surveys and had 8 back. The analysis of the results is completed and they are in the process of writing a short report. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The annual quality assurance assessment told us that the heating system and gas appliances were serviced in April 2009. All fire checks were up to date and a fire risk assessment was in place. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 6 9 The care plan should clearly evidence that the individual has been involved in the development of the document. To ensure that people using the service are able to take responsible risks staff should have good information on which to base decisions so it is important that within an individuals care plan and risk assessment accurate information is recorded such as the safe water temperature in which someone can bathe. The registered provider should ensure that if an individual chooses not to eat at meal times, the reason is clearly recorded and they also record what other options where offered. 3 17 Care Homes for Adults (18-65 years) Page 25 of 26 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. 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