Care Home: Prospect House

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What the care home does well The home is near to the centre of Spilsby and within walking distance of shops and other local facilities. People said they liked living near to the shops. People are cared for in a clean and comfortable environment and the home is decorated to a good standard. All people spoken with made positive comments about the care they received; one said it would never be home but it was the next best thing and another said that she enjoyed sitting on the decking area at the rear of the building in sunny weather. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager and senior staff work well as a team and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. Surveys returned to us were very positive and comments included praise for the staff and the manager. What has improved since the last inspection? Different medias being looked at for making information more service user friendly. person centred plans having identified goals and aspirations which has enabled developments in these areas including moves towards further independence. As a company Linkage are training ten new facilitators one which is based in Spilsby. Support service users via the pointers committee which is a service user group led by an independent advocate. The home also piloted a shut down holiday week for Employment Services and put on special day trips to different venues during this week. further developed knowledge of health lifestyle issues and promotion of these within the home. The home has a Linkage physiotherapist, which one service accesses. Hospital passports have been introduced for all service users. all areas being decorated and communal areas having new carpets. Downstairs bathrooms changing shift patterns to include waking night shifts. making training venues more centralised for all staff, with two training venues in Louth. What the care home could do better: Windows on the first floor must be restricted to avoid accidents from people falling out. Key inspection report Care homes for adults (18-65 years) Name: Address: Prospect House 14 Boston Road Spilsby Lincs PE23 5HD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Western     Date: 0 5 0 2 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 24 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Prospect House 14 Boston Road Spilsby Lincs PE23 5HD 01790752531 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Linkage Community Trust care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Prospect House is a care home operated by a voluntary organisation called Linkage Community Trust Care Services. It is a detached two-storey house situated in a residential area of the market town of Spilsby and is registered to accommodate six people who have a learning disability. The home has its own small garden area, equipped with patio furniture and is sited close to the local shopping area, with a supermarket opposite. Public transport is readily available, linking Spilsby with Boston and the coastal town of Skegness. Accommodation is provided in six single occupancy rooms, four on the ground floor and two on the first floor. There is a ground floor bathroom, shower room and toilet and a first floor bathroom and toilet. The home is part of Linkage Community Trusts long-stay project, which also operates Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 6 Brief description of the care home a day centre facility at Scremby Grange, approximately four miles from Spilsby. The residents are able to access this facility and as part of their personal development, are also involved in community work experience projects. The homes stated aims are to create a stimulating and challenging environment for adults with a learning disability anf other disabilites. The current weekly fees for the service range from £562 to £567 and information about these and the facilities the home has to offer are available from the manager. Care Homes for Adults (18-65 years) Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted approximately three hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people before we visited the service. The main method of collecting information during this visit is called case tracking, Care Homes for Adults (18-65 years) Page 6 of 24 which includes following the care of a sample of three people through their records and assessing their care. We spoke to two people who use the service and saw rooms of those people who said we could and to three staff members. The manager and the manager of another home in the organisation were present throughout the visit and the general outcomes of the visit were discussed with them. Care Homes for Adults (18-65 years) Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 24 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 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a thorough assessment and can be assured that their needs will be met. Evidence: We saw the service user guide, which contained up to date information about the type of care the home can provide. Photographs of the home and the activities it offered supported the written information. The statement of purpose we saw was up to date and gave details about the facilities provided. Assessments were in place for each person and covered needs such as communication, self care, independence skills, health care, diet, behaviour and leisure. The assessments were very detailed and clearly showed the wishes and preferences of each person. Records were reviewed and updated regularly. The records also showed that people, where they were able, relatives and other relevant people were involved in carrying out the assessments. Care Homes for Adults (18-65 years) Page 10 of 24 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. Detailed care plans help students to develop their independence, whilst risks are minimised. They are consulted about their daily lives, and supported in an individualised and respectful way. Evidence: We saw care plans for three people. All were very detailed and linked clearly to their assessments. They included needs such as communication, self-care and health care. The plans showed likes and dislikes and how people made their own choices or decisions. Privacy and dignity were also reflected in care plans. Risk management plans were in place, and covered needs such as mental state, kitchen access, vulnerability and travel. They also covered any restrictions to choice or freedom where there was a high risk to health or safety. The reviews were carried out monthly and gave people an opportunity to express their views about house issues, leisure activities and any concerns or complaints they might have. They showed that people understood their care plans and agreed to them. People we spoke with said they looked at their files with their key workers and their Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: relatives. They also said they had house meetings where they could give their opinions. Surveys said that people have a good quality of life at the home. They also said that people are helped to maintain and develop their independence. We saw that the staff have a very clear understanding of the needs of each person. They were seen offering choices in whatever way the individual could understand, for example using objects of reference, pictures, gestures or verbally. They also responded to people in a respectful way, and offered gentle reassurances where necessary. Care Homes for Adults (18-65 years) Page 12 of 24 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 benefit from a wide range of social and educational opportunities, which help them to develop their skills and live a fulfilling life. Evidence: We saw that people had individual daily programmes, including evenings and weekends. These clearly showed leisure, educational and home activity. Activities such as meal preparation, walks, art, shopping trips, music sessions, community based sports sessions, social clubs and meals out are offered. People we spoke with said they liked to do things such as going to the shops, going horse riding and going to church. People described what they did on their annual holidays, including a trip to Disneyland and hotels in Yarmouth. All people attend the Linkage employment services centre at Scremby Grange, where a job carver is employed to help people find work placements and settle them into Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: work. One person was working towards her National Vocational Qualification, a nationally recognised award, in catering. On the day of the visit three people were at the centre and three people were at home tidying their rooms and going shopping later. Staff respected the decisions of people not to join in with activities. We saw that games, puzzles and videos or DVDs were available in the home. There was a computer for people to play games or send emails to their families. Two said they often visited their families for weekends and their rooms had personal effects, photographs and evidence of family relationships being maintained. Menus were developed on a weekly basis so that people to relate the shopping they do more closely to the meals they make. We saw staff ask people what they wanted to eat before the lunch time meal was prepared. Choices were also offered for desserts. Staff helped people to take part in preparing, and cooking the meal. People we spoke with said that they enjoyed their meals, and described their favourite foods, which were present in the home and in the menus. Care Homes for Adults (18-65 years) Page 14 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements to make sure that the health needs of people are met, and they are protected by the medication policies and procedures. Evidence: We saw medical files for each person, containing information about their health needs, and this information linked with care plans. They showed staff how to support needs such as behaviours and epilepsy and emotional needs such as anxiety. Records we saw showed when people saw health professionals such as a GP, dentist or optician and they showed that things like weight and seizures are monitored. People have an allocated key worker so that they have a consistent support network. Staff we spoke with told us that they know the health needs of people very well and were able to describe how needs such as epilepsy are managed. They also made sure that any personal support was provided in a private and dignified way, and they respected decisions about people wishing to take their own medications where it was safe to do so. Records show that staff receive training in how to administer medications in a safe way. There is a company policy regarding general administration of medicines and staff followed the procedures satisfactorily. Care Homes for Adults (18-65 years) Page 15 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by clear procedures for handling complaints and allegations of abuse, and by the knowledge of staff who are well trained. Evidence: Since the last inspection there has been one complaint to the home, and records show that it was managed and resolved in line with the complaints policy. The complaints policy is in personal files and is available in sign language and DVD formats. People sign to say they have the policy and have understood it. Staff demonstrated a good knowledge of what abuse is and how to protect people. We saw records showing that they receive training in this subject. Any restrictions to choice or freedom are referred to in care plans. Care Homes for Adults (18-65 years) Page 16 of 24 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 enjoy a clean, comfortable and homely environment, which is well maintained. Evidence: A tour of the building showed that the home was very clean and tidy throughout, with the exception of some scuffing to the paintwork on the staircase and banisters. The manager said she was aware of this and it would be redecorated by the organisation maintenance team. People we spoke with said they knew and liked the maintenance team when they visited. First floor windows did not have restrictors on them and opened fully enough for people to fall out of. Two people showed us their new rooms and said how much they liked their rooms. They described how they chose their own colours and furnishings for the rooms. Other bedrooms were decorated to a high standard. Communal areas were comfortably furnished and there were photographs around the home of the people who live there. The kitchen was well equipped, with a large family size dining table where people said they preferred to eat. There was a laundry room where all hazardous substances were locked away safely. Care Homes for Adults (18-65 years) Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well-trained and supported staff team ensures that people are cared for safely. Evidence: The staff rota we saw showed that in addition to the manager there were two staff members for three people, the other three people being away from the home. In emergencies the manager could also contact other Linkage homes for backup support. We looked at records for three staff members. The recruitment records included criminal record bureau checks, application forms and two written references. They also contained identification and interview records. People we spoke with said that they helped to choose new staff and staff confirmed this. Staff told us they received a good induction and training package, and records we saw confirmed this. Training records showed that all except two members of staff have achieved the NVQ at level 2 and one is currently working towards it. Staff said that they receive training in subjects such as fire safety, moving and handling, and medication administration. The training plan showed that all regulatory training is undertaken on a rolling programme, with specialist issues such as autism, signing and behaviour management as staff require it. Records show that supervision sessions are carried out regularly with staff, and they confirmed this during discussion. They said that supervision helps them to look at Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: their personal development, and they are able to voice their views and opinions. They said that there is good teamwork within the home. We saw records of team meetings held every two months. Care Homes for Adults (18-65 years) Page 19 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, which means that people receive a good standard of care and support. The systems within the home protect their health, safety and welfare needs. Evidence: The new manager is not yet registered but has applied for registration. Staff said that they have good management support, and there is an on-call managers rota in place. The organisation has its own health and safety officer who carries out regular risk assessments of the building. Pre inspection information shows that there are a range of health and safety policies in the home such as fire safety, infection control, and moving and handling. The organisation has its own fire safety officer and records are available to show that fire safety equipment is checked regularly and there is a fire risk assessment in place. We saw risk assessments in place for hazardous substances, the environment and issues such as travelling away from the home. There are comprehensive quality assurance processes in place involving the people, their relatives and other stakeholders. The Pointers Group, an advocacy led group for service users, meets regularly and the reports from these meetings and results from Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: the questionnaires sent out are acted upon by the management team. Representatives of the provider company visit the home regularly to monitor the services. The quarterly Linkage News is sent to all people, their relatives and advocates. It gives up to date news about the organisation. The organisation was awarded the Investors in People business award in July 2009. Care Homes for Adults (18-65 years) Page 21 of 24 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 22 of 24 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 24 13 First floor windows must be restricted. To prevent possible accidents from people falling out. 08/04/2010 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 Care Homes for Adults (18-65 years) Page 23 of 24 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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