Care Home: Queen Elizabeth House

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Annual service review Name of Service: Queen Elizabeth House The quality rating for this care home is: The rating was made on: three star excellent service 1 3 1 0 2 0 0 8 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 review of the service. We call this review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Chris Schwarz Date of this annual service review: 2 8 0 9 2 0 0 9 Annual Service Review Page 1 of 8 Information about the service Address of service: National Society for Epilepsy Chesham Lane Chalfont St Peter Bucks SL9 0RJ 01494601300 01494601300 andrew.ferguson@epilepsynse.org.uk www.epilepsysociety.org.uk The National Society for Epilepsy Telephone number: Fax number: Email address: Provider web address:   Name of registered provider(s): Conditions of registration: Category(ies) : learning disability physical disability Conditions of registration: Number of places (if applicable): Under 65 Over 65 20 20 0 0 The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Have there been any changes in the ownership, management or the Yes service’s registration details in the last 12 months? If yes, what have they been: The service has increased to provide accommodation to 20 people. 1 3 1 0 2 0 0 8 Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service Queen Elizabeth House is a purpose built service providing care for people who have epilepsy and physical or learning disabilities. It is one of a number of services on one site at Chalfont St Peter and is managed by the National Society for Epilepsy. There are 20 single en-suite rooms which have been designed to meet the needs of people with disabilities. There are lounges and dining rooms and people can use the facilities Annual Service Review Page 2 of 8 of the site, which include a therapy service and small shop. The village of Chalfont St Peter is a bus or taxi ride away as are the nearest shopping centres. The service is staffed by qualified nurses and carers and people living there have the support of a multi disciplinary team including specialist consultant neurologists, psychologists and other therapists. Information about the service can be obtained by visiting or telephoning. Annual Service Review Page 3 of 8 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at all the information that we have received, or asked for, since the last key inspection which took place on 13 October 2008. This included: 1. The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. 2. Surveys returned to us by people using the service and from other people with an interest in the service. Four surveys were returned from people using the service and two from social and health care professionals. 3. Information we have about how the service has managed any complaints. 4. What the service has told us about things that have happened in the service, these are called notifications and it is a legal requirement for the service to tell us about them. 5. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. 6. Relevant information from other organisations. 7. What other people have told us about the service. What has this told us about the service? The Annual Quality Assurance Assessment was returned in good time to carry out this assessment of the service and had been completed to a high standard. It showed that views are sought from people using the service through forums such as an annual survey, residents meetings and regular reviews of peoples placements. The manager informed us that improvements had been made after listening to service users such as introducing flexible mealtimes and that a communication workshop took place to improve communication between relatives and staff. Work has taken place to improve staff levels of empathy toward people with complex communication needs and learning disabilities and a video has been produced of service users from the site sharing their experiences, which new staff are now required to watch. The service has increased its number of registered places from twelve to twenty this year after a new extension was completed. At the time the Annual Quality Assurance Assessment was competed (June 2009) there had been one new admission. The manager said the needs of existing service users had been taken into account and some have moved into the new rooms to better meet their care needs. We were advised that the service continues to have a statement of purpose and service users guide in place and these are accessible to users and visitors in the entrance hall and kept updated. The manager described a thorough pre-admission assessment process that included prospective users being invited to visit and a series of assessments to ascertain care requirements. Information provided in the Annual Quality Assurance Assessment showed that care plans are in place for people using the service and that they are supported to contribute to these. The plans are kept under regular review and updated as necessary. People have a named nurse and key worker. One member of staff has Annual Service Review Page 4 of 8 completed a train the trainer course on person centred planning. The manager said staff are continuing to develop video care plans and have purchased a computer system and cameras to progress this work. Communication passports are being produced to improve peoples experiences of going into hospital and to ensure continuity of care. We were advised that the service users computer has been upgraded to have a variety of switches, programmes and internet access in order to be accessible to all. We were advised in the Annual Quality Assurance Assessment that the service has been looking at consent and capacity issues and that deprivation of liberty issues have been looked at for all of the people using the service. The manager advised that people using the service are supported to engage in meaningful activities and that there are links with local colleges, an onsite therapy department and a learning and skills department. We were advised that each person has a personalised activity plan and a personal development record, which are kept under review. Off site activities also take place and this has been improved through acquiring a driver and more staff being able to use the National Society for Epilepsys transport. The manager advised us that menus are kept under review and that a dietician regularly supports the service. Improvements have been made such as producing enhanced menus through use of photographs and recipes for each menu, acquiring a fridge specifically for defrosting meat and a new style of training on food handling which involved people using the service and staff. Information provided in the Annual Quality Assurance Assessment reflected continuing good practice in meeting peoples personal and health care needs. Safe behaviour management training takes place and physical intervention plans are drawn up where necessary. Care plans outline the support each person requires and people using the service have access to a range of medical professionals to keep them healthy and well. Staff handover sessions ensure important information is communicated to staff. Aids and adaptations are in place to assist with daily living tasks, such as raised toilet seats and hoists. The design of the building is to a high specification to take into account needs arising from physical disabilities. Two nurses have completed a nursing course on advanced practice in epilepsy. The manager has undertaken a train the trainer course on first aid and one of the senior nurses has agreed to become a safeguarding trainer. There are plans to train someone to become an infection control trainer. The manager advised that there are complaints procedures in place at the service and a pictorial version of this is included in the service users guide. There are copies of the procedure displayed in the building. Staff receive training on safeguarding vulnerable adults and there are plans to deliver training for people using the service. Three complaints and one safeguarding issue were identified in the statistical information provided by the manager. The service is divided into two six bedded and two four bedded units, all with single en suite bedrooms. All accommodation is on ground level and bedrooms have doors leading to patio areas. People are encouraged to personalise their rooms and are consulted about decor and furnishings. The original part of the building has been improved through redecoration, fitting of some new carpets, some new armchairs have been purchased and an electric organ has been bought for music sessions. Two games consoles have been purchased which respond to individual movements. The new part of the building has a walled garden which is being developed by people using the service with support from staff. The idea of keeping chickens is being considered. Annual Service Review Page 5 of 8 The manager described thorough recruitment processes and involvement of service users in attending job fairs and in interviewing prospective staff members. Induction of new staff follows the Skills for Care common induction standards and people using the service are asked to provide feedback on staff performance before they are confirmed in post. Handovers and staff meetings take place and there are systems for supervising and appraising staff. The manager advised that there have been difficulties in recruiting qualified nurses and an experienced senior nurse has transferred from another part of the site for a six month period to help support the service. The service is also working with a local university to sponsor six return to work nursing placements. The service now has an administrator position and the new extension gave rise to the creation of two team leader positions. The manager is an experienced and qualified nurse and is registered with the Commission. Information provided in the Annual Quality Assurance Assessment reflected a drive to keep improving the service, adherence to good practice and involving service users, staff and relatives in developing the service. He has completed a leadership and management programme and keeps up to date with training. The manager has kept us informed of significant events at the service which affect peoples welfare. Various audits were described to assess and improve quality of care, such as medication, health and safety and care plan audits. He advised that changes have been made to handling service users money to provide better safeguards. Statistical information showed that there is good regard for health and safety with regular servicing of equipment, an action plan and training on best practice on prevention and control of infection, nutritional screening for all newly admitted people and training in safe food handling. The manager has also been developing three nurse roles in infection control, fire safety and health and safety. People using the service said in surveys that they had been asked if they wanted to move into the service. They considered they had been given enough information about it to help decide if it was the right place for them. They said they sometimes make decisions about what to do each day and can do what they want during the day, in the evening and at weekends. People using the service said they knew who to speak with if they were unhappy and how to make a complaint. They said the premises are usually kept fresh and clean and that staff and managers treat them well and act on what they say. Two people said the food was good at the service. One person said the service could improve by repairing things more promptly. Two surveys were received back from social and health care professionals who work at The National Society for Epilepsy. They said that the services assessment arrangements usually ensured that accurate information is gathered and that the right service is planned for people. They said peoples social and health care needs are properly monitored, reviewed and met. They said the service usually seeks advice and acts on it to meet health care needs and improve well being. They considered that medication was usually appropriately managed and that peoples privacy and dignity were usually respected. They said the service usually supports people to live the life they choose wherever possible and that staff and managers usually have the right skills and experience to support people. They considered that peoples needs arising from equality and diversity were usually responded to and that the service responded Annual Service Review Page 6 of 8 appropriately if they had raised any concerns. One commented the service provides care and support to clients with very complex needs. The manager and his staff are very indulgent of their clients needs, often going the extra mile. There is a relaxed, homely atmosphere and the clients always appear fond of staff and comfortable in their presence. Staff seem able to cope with the demands of this client group and have developed real skills in this area. The person felt the service would benefit by recruiting staff who have experience in working with people with mental health problems to add to collective team skills. The information that has been provided in order to carry out this review indicates that the service continues to provide a good standard of care to people living at Queen Elizabeth House and that we do not need to alter our planned inspection schedule. What are we going to do as a result of this annual service review? The next key inspection of Queen Elizabeth House will be carried out before 12 October 2011 to review our assessment. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using it. Annual Service Review Page 7 of 8 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. The content of which can be found on our website. 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