Care Home: Rectory House

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What the care home does well One resident said "...Linda does a good job...". Another said "...it`s good coming here..." and a third told us "...the food is excellent!...". Some of the residents weren`t able or willing to make comments but they indicated in various ways with nods, a `yes` or `no`, a smile and touching things on a personal planner in response to our questions about their daily lives at Rectory House. We observed staff being patient with residents, allowing them time to make choices, for instance about whether to go out or not, about whether to invite us to see their room.Rectory HouseDS0000073239.V375985.R01.S.docVersion 5.2 What has improved since the last inspection? This is the first key inspection since the new owners took responsibility for running the home. What the care home could do better: Key inspection report CARE HOME ADULTS 18-65 Rectory House Rectory Lane Harrietsham Maidstone Kent ME17 1HS Lead Inspector Christine Lawrence Key Unannounced Inspection 16 June 2009 10:15 Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 2 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 Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rectory House Address Rectory Lane Harrietsham Maidstone Kent ME17 1HS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) European Lifestyles (FL) Ltd Mrs Linda Cochrane Care Home 14 Category(ies) of Learning disability (0) registration, with number of places Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 14. Date of last inspection New service Brief Description of the Service: Rectory House provides personal care and accommodation for a maximum of 14 people with a learning disability. The house is a three storey detached property set in its own extensive grounds. Accommodation and facilities for the residents are provided on the ground and the first floor. The home is situated in the village of Harrietsham. Local amenities, including shops, pubs, a restaurant, doctors surgery, bus stop and railway station are within a half-mile radius. The home provides car-parking facilities to the front of the property. Currently the home is used by male service users only. The current fees are between £650 and £1350 per week. Fees are based on individuals’ support needs agreed before admission. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a 2 star good service. We, that is the Care Quality Commission (CQC), visited the home unannounced on the 16 June. We were in the home from 10:15 until 16:45. The manager sent us an annual quality assurance assessment (AQAA) when we requested it. This is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we get information from providers about how they are meeting needs and wishes, and achieving positive outcomes for people using their service. The AQAA also provides us with statistical information about the service. The AQAA completed for Rectory House was informative and clearly written. Three residents showed us their rooms and answered our questions about the home. Three others were around at various times and also spoke to us about Rectory House or answered our questions. Four other people were also around at various times during the day but did not speak with us directly. We sent out five surveys for residents and five surveys for staff. Two staff surveys were returned. We spoke to two staff and one relative. The registered manager, Linda Cochrane, was present throughout the visit. During the visit we looked at care plans (including separate guidance for morning routines and personal support), incident and accident reports, records of activities and participation, records of plans for activities, menus, the rota, two staff records, a training matrix and medication administration records. Information from the CQC National Provider Relationship Manager, who meets with the organization on a regular basis, was also read prior to the visit. What the service does well: One resident said “…Linda does a good job…”. Another said “…it’s good coming here…” and a third told us “...the food is excellent!...”. Some of the residents weren’t able or willing to make comments but they indicated in various ways with nods, a ‘yes’ or ‘no’, a smile and touching things on a personal planner in response to our questions about their daily lives at Rectory House. We observed staff being patient with residents, allowing them time to make choices, for instance about whether to go out or not, about whether to invite us to see their room. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 6 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. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents individual aspirations and needs will be assessed. EVIDENCE: We looked the assessments and care plans for three of the people living at Rectory House. One of those was for someone who has not lived in the home for very long. This record contained a comprehensive assessment which included information from the placing authority as well as a relative. This information included things like communication, self care skills, mental health and behaviour, physical health, medication skills, activities and what the person liked to do, relationships and whether or not the person wished to practice a religion. It also identified some of the support that the person would need if the moved into Rectory House. There was also information from the place the person lived in before moving to Rectory House. All of this information helps the home to decide if they can meet someone’s needs. This also tells the home all about them, what they hope for and want to achieve, and the support they need. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their changing needs will be noted in their individual plans and that they will be supported to make decisions and take risks to enable as independent lifestyle as possible. EVIDENCE: We looked at three assessments and care plans for this inspection. The assessments are used to create a plan of care which helps staff meet the needs and wishes of the people living in Rectory House. The home is starting to use a new format for doing this. It is person centred, that is, is written from the point of view of the individual. The manager, Linda Cochrane, informed us that they are gradually changing over to this format. Existing information is clear and at the moment the two ways of recording are side by side until the new format is in place for all people. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 10 The two staff surveys which were completed for this inspection both had ticks against ‘always’ in answer to the question “Are you given up to date information about the needs of the people you support or care for?” A relative told us that the home involved them and the person living in Rectory House with looking at needs and how to meet them. The care plans have a section entitled ‘My Daily Routine’ and this is followed by ‘How to support me! What I can do myself’. This provides information about what an individual’s preferences are and how, if at all, they need to be supported. The care plans we saw showed that people are different and are therefore supported differently. For instance some people need lots of support to make decisions and others are able to make decisions themselves. This might be for times to get up and go to bed, managing money and deciding what to spend it on, whether to attend an activity or not and spending time alone or with others. Risk assessments are in place for various things. They reflect that the staff wish to enable and encourage people to do things as safely as possible rather than not do things at all. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and involvement in the local community, as well as support for personal relationships will be provided for residents. They will benefit from having a healthy diet. EVIDENCE: Residents’ individual records, as well as what they told us and what we observed, showed us that residents have a variety of activities both within and outside the home. Much of this takes place within the community and includes college courses, garden and conservation projects, day centres, swimming, bowling and attending church. Some things are accessed via public transport and others by one of the home’s two vehicles. We noted examples of residents being supported to spend time with relatives and at the time of this visit one person was away visiting family, another was Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 12 out for the day with a relative and another had spent time with a relative but arrived back during the day. People living at Rectory House are encouraged and expected to do various chores both communal and personal such as washing up, laundry, keeping rooms tidy, helping to prepare meals etc. People said they enjoyed the food - “The food is excellent. I don’t like curries or chillies, they do my favourite – Pigs in Blankets or Toad-in-the-Hole”. We saw pictorial menus to help some people make choices. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the homes policies and procedures regarding medication and their physical and emotional needs will be responded to. Their preferences and requirements for support are respected. EVIDENCE: The care plans and assessments seen contained information for staff about how to support residents and the manager is currently completing more focussed guidance relating to personal care and morning routines. We saw four of these that had already been completed. This will ensure that all staff are aware of individuals’ preferences. Both the care plans and the separate guidance make it clear about what a person can do for themselves and what they need help and support with. This means that people are encouraged and enabled to be as independent as possible. Health action plans are being used in the home to identify needs and to record how they can be met. We saw that various health care professionals are accessed both routinely and as required including chiropodist (paid for by the registered provider), dentist, Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 14 GP, community nurses, psychiatrist, physiotherapist, sensory specialist nurses etc. Medication is stored appropriately. The medication records were mostly properly completed; there were no signatures for one person’s medication. We discussed with the manager the importance of things being signed as they are given, not later. She agreed to remind staff about this. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents views are listened to or ascertained, and acted on. There are systems and written procedures in place to inform staff about protecting vulnerable people. EVIDENCE: We saw that information about how to complain was on display in the hallway. The manager confirmed that there is a commitment to investigate any complaint as quickly as possible but certainly within 28 days. There was also a poster on display entitled “What do you think?”, which invites comments about the service. We asked one resident about who he would talk to if he was unhappy about something and he said “…Linda [the manager] or all the staff…”. Staff told us that the weekly 1:1 key worker sessions gave residents the opportunity to talk about things before they became problems. Staff have received adult protection training and there are policies and procedures in place to underpin this. Examples were noted of the service responding appropriately to social services’ requirements as a result of safeguarding adults alerts. Staff confirmed their understanding of their responsibilities and said “… Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home which is homely and comfortable as well as clean and hygienic EVIDENCE: Four residents showed us their rooms. The rooms were individual and reflected their choices and preferences. One person has a drum kit in his room and another has lots of bits and pieces and has facilities for making tea and coffee etc. One person has a Manchester United theme and one had a daily planner on display. One person told us “…I really like my room…” others were not able to articulate their feelings but were clearly pleased to show their rooms to us. The rooms seen were satisfactorily decorated and furnished. Some of the residents also assisted in showing us round the communal areas. The lounge is large and has various chairs and sofas. The décor is satisfactory and there are personal touches such as football trophies on display. The Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 17 dining area is also an area where people can sit and chat and watch what’s going on in the kitchen and we saw that towards the end of our visit, as people came back from activities and outings. A maintenance man is employed. The house is on the outskirts of the village and there are two vehicles available to take residents out and about and public transport (buses and mainline train station) can be accessed. There is a large garden which residents can and do use. During our visit one person was enjoying riding his bike around the garden. The home was clean and fresh on the day of the inspection. All bathrooms and toilet facilities were satisfactory. We were informed that the laundry area was being decorated and re-organized. There is a washing machine with a sanitizer programme. We noted from the AQAA that all staff has received food safety training and four people have received infection control training. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sound recruitment procedures and training already provided and training planned, will have a beneficial impact on residents. EVIDENCE: We looked at the rota which is used to show who is on duty and what their role is. The team leader in charge of the shift has a book which they use to plan the shift. We looked at the one being used for that day. It indicated who was going out and who would be accompanying them; any appointments such as GP visits and any family visits. The rota showed that some staff work long days and others simple shifts. The manager said this gives flexibility if any outing or activity involves the whole day. We were informed by Linda Cochrane, the manager, that due to staff shortages it has been decided to use agency staff to cover some shifts while recruitment is ongoing. We saw the training matrix which identified what training people had and still need to have. The manager informed us that the organization’s training manager is currently reviewing training requirements. The AQAA contained Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 19 information about national vocational qualifications (NVQs), indicating that six people have achieved these and eleven are working towards achieving this qualification. Induction training based on the common induction standards from Skills for Care, is now being used in the home. This was confirmed by two staff on duty, one of whom is currently working through and induction booklet and also in the two surveys completed by staff. In answer to the question “Did your induction cover everything you needed to know to do the job when you started?”, one person ticked ‘very well’ and another ticked ‘mostly’. We observed staff in different situations with residents and saw that they were listening to what was said to them, or watching residents to try and ascertain what they were trying to express. Residents were given time to do things or encouraged to slow down, according to their individual ways of doing things or communicating. This included supporting people in showing us their rooms, asking about going out, helping in the kitchen and responding to requests to do something. We looked at the records of two members of staff, one of who was recently employed. They showed that application forms are used and people have formal interviews. They have to provide three referees and complete a medical questionnaire. There are planned questions for interviews and an interview checklist; this is part of the equal opportunities policy. A form is also used for monitoring diversity. Residents said the following things when asked about the staff:- “They do a good job” “…yes, good job…” “…everything is OK…” “…it’s good coming in here…”. One person smiled and looked at the member of staff in the room when we asked if the staff were kind and helpful, and another nodded his head in answer to a similar question. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home and their health and safety is promoted and protected. EVIDENCE: The manager has been in post for three years. She has achieved the registered manager’s award and she has more recently attended training/awareness sessions regarding person centred planning and the Mental Capacity Act. She informed us that she has over 10 years experience working with people with learning disabilities. Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 21 We saw copies of reports of visits undertaken by the organization’s representative under Regulation 26 of the Care Homes Regulations, which is how providers monitor the service provided to ensure standards are being met. We were informed that residents are given opportunities to attend residents’ meetings. No surveys have been sent out/given to residents or their representatives under the new owners but we were informed that this will happen. We were informed by the commission’s National Provider Relationship Team that managers are expected to complete twice yearly quality audits that have been designed to mirror the National Minimum Standards and they also have to complete health and safety audits. This was confirmed by the manager of Rectory House. She also confirmed that the AQAA completed for this inspection would also be used as a monitoring tool to look at how the service is performing and what could be improved. We also saw a poster on display – “What do you think?”, with forms that can be completed reflecting visitors’ opinions about the service. The AQAA indicated that policies and procedures were reviewed in July 2008. We were informed that they will all eventually be reviewed and updated in keeping with the new organization. The AQAA indicated that service and maintenance contracts were appropriate and up to date and we did a spot check on some of these to confirm that. We saw no hazards during our time within the home. The training programme includes health and safety, food hygiene, infection control, first aid, manual handling and fire safety. As noted previously not everyone has completed everything but the manager informed us that the organization’s training manager is currently reviewing training needs. The manager is due to attend a four day health and safety course in the near future. A poster was on display indicating the ‘Scores on the Doors’ was excellent (this is a national public information service which lists official local authority hygiene ratings for food businesses). Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 23 Rectory House DS0000073239.V375985.R01.S.doc New service Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rectory House DS0000073239.V375985.R01.S.doc Version 5.2 Page 24 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiriessoutheast@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. 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