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Care Home: Rix House

  • 24 Arncliffe Road Keighley West Yorkshire BD22 6AR
  • Tel: 01535600420
  • Fax:

Rix House is located in a residential area of Keighley, close to local shops and about one mile from the town centre. In April 2002 the home became part of the newly formed Bradford District Care Trust. The Trust brought together the Health Authority and Social Services in one organisation to provide and promote mental health and learning disability services throughout the Bradford Metropolitan District. The home is presently registered to care for twenty people between the age of eighteen and sixtyfive who have a learning disability. Fifteen people live at the home on a permanent basis and there are five rooms for people who receive respite care at the home. There is level access to the main door of the home, which enables easy access for everyone with mobility problems and wheelchair users. Unfortunately there is no passenger lift available to the first floor of the building and therefore this area is not accessible to people with mobility problems. The home stands in substantial grounds and there is a car park to the front of the property. Information on fees at the home can be gained by contacting the manager of the service. 7112008

  • Latitude: 53.860000610352
    Longitude: -1.9240000247955
  • Manager: Jacquelyn Shakespeare
  • Price p/w: £63
  • UK
  • Total Capacity: 20
  • Type: Care home only
  • Provider: Bradford District NHS Trust
  • Ownership: National Health Service
  • Care Home ID: 13086
Residents Needs:
Learning disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Rix House.

Key inspection report Care homes for adults (18-65 years) Name: Address: Rix House 24 Arncliffe Road Keighley West Yorkshire BD22 6AR     The quality rating for this care home is:   one star adequate 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: Dawn Navesey     Date: 2 0 0 1 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 38 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 38 Information about the care home Name of care home: Address: Rix House 24 Arncliffe Road Keighley West Yorkshire BD22 6AR 01535600420 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jacquelyn.shakespeare@bdct.nhs.uk Bradford District NHS Trust care home 20 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 Rix House is located in a residential area of Keighley, close to local shops and about one mile from the town centre. In April 2002 the home became part of the newly formed Bradford District Care Trust. The Trust brought together the Health Authority and Social Services in one organisation to provide and promote mental health and learning disability services throughout the Bradford Metropolitan District. The home is presently registered to care for twenty people between the age of eighteen and sixtyfive who have a learning disability. Fifteen people live at the home on a permanent basis and there are five rooms for people who receive respite care at the home. There is level access to the main door of the home, which enables easy access for everyone with mobility problems and wheelchair users. Unfortunately there is no passenger lift available to the first floor of the building and therefore this area is not accessible to people with mobility problems. The home stands in substantial grounds and there is a car park to the front of the property. Information on fees at the home can be gained by contacting the manager of the service. Care Homes for Adults (18-65 years) Page 4 of 38 Over 65 0 20 0 7 1 1 2 0 0 8 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 38 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: one star adequate 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 1 star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 1-40pm until 9-40pm on the 20th January 2010. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who use the service. And also to Care Homes for Adults (18-65 years) Page 6 of 38 monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was well completed and gave us all the information we asked for. Survey forms were sent out to people using the service, staff and health care professionals. Due to an administrative error, none of these have been available to the inspector. However, we looked at the homes own surveys that had been returned to them and used some of the comments in this report. During the visit a number of documents and records were looked at and some areas of the home used by the people staying at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff and the manager. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Feedback at the end of the visit was given to the manager. Care Homes for Adults (18-65 years) Page 7 of 38 What the care home does well: People who use the service told us they liked living at the home. One person said, I love it here, its a great place, everything is good. Another said, Happy with where I live and people who care for me. Other people who were not able to use verbal communication, nodded and smiled when asked if they were happy at the home. A health professional said that people say they are very happy living at the home. People said they liked the food. One person said, Its always beautiful. A health professional said, High standards of food provision. Staff are positive/considerate towards service users in their cultural/religious beliefs and helping them make choices by having a picture menu. Despite the gaps in care planning as mentioned in the individual needs and choices section of this report, staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live or stay at the home looked well cared for, well dressed and groomed. People who use the service, their relatives and health professionals spoke highly of the staff. Their comments included: We have a great staff team I love the staff here Staff always do their best Staff are doing their best for (name of person) Staff are on the whole very good and do their best. The manager has involved people who live at the home in interviews for new staff to get their involvement in choosing staff. One person told us how much they enjoyed doing this. Staff said all their training and induction was good and that any updates they needed were always provided. Their comments included: Very good training, they make sure we get what we need Very good when you first start Staff and people who use the service spoke highly of the management team. Their comments included: We all like the manager Very professional Care Homes for Adults (18-65 years) Page 8 of 38 Manage things well, always chase things up for the benefit of people who live here They try their best for everyone Managers great, very good support Approachable, support us well. What has improved since the last inspection? What they could do better: Some consideration should be given to reviewing the mix of the provision of both respite care and permanent placements of people at the home. This is to make sure peoples needs are properly met. We looked at care plans and risk assessment records for people who use the service for respite care. We found these to have a number of shortfalls which could lead to peoples needs being overlooked. All people who use the service should have detailed Care Homes for Adults (18-65 years) Page 9 of 38 care plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. All risks to people who use the service must be identified and assessed. This will make sure that practice is safe and peoples needs are fully met. The meal time we observed was not well organised or neither did it seem to be a time for people to relax, socialise and share a meal. The way meal times are organised should be reviewed to make them a more relaxed and social occasion. And some consideration should be given to increasing opportunities for personal development of peoples independent living skills, especially at mealtimes. Nutritional needs must be assessed and monitored for people who use the service who are nutritionally at risk. This is to make sure their needs are properly met. Peoples health care needs must be reviewed to make sure they are recieving the support and health care they need. This is to make sure that peoples health care needs are fully met and they get the health care they need at the time they need it. People should be referred promptly for any specialist health care support they need and these referrals should be regularly followed up to make sure they are not forgotton. Medication administration systems need to be more robust to ensure peoples needs are properly met. Handwritten entries on MAR (Medication Administration Record) sheets should be checked and countersigned by a second person to make sure the information is correct and people receive the right medication. Guidelines must be in place for the administration of as and when required medication. This is to make sure people are given the right medication when they need it and their needs are not missed or overlooked. Safeguarding adults procedures must be followed at all times for all allegations or incidents of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. The laundry floor must be replaced with a suitable floor covering. This is to make sure it is kept clean and hygienic for people. The CQC must be notified of any events which affect the welfare of people who use the service. This is to make sure that the health, safety and welfare of people who use the service is protected properly. Visits by or on behalf of the registered provider should take place on a monthly basis to make sure the home is monitored properly and people who use the service have an opportunity to air their views about it. Some consideration should be given to seeking independent advocacy for people who do not use verbal communication so that their views may be able to be better represented when giving feedback on the service. 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. Care Homes for Adults (18-65 years) Page 10 of 38 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 11 of 38 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 12 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with enough information to enable them to make an informed choice about the home. The admission process includes pre-admission assessments to make sure that peoples care needs can be met. However, the combination of the provision of respite care and permanent places could lead to peoples needs not being met properly. Evidence: People who use the service told us they liked living at the home. One person said, I love it here, its a great place, everything is good. Another said, Happy with where I live and people who care for me. Other people who were not able to use verbal communication, nodded and smiled when asked if they were happy at the home. A health professional said that people say they are very happy living at the home. In the AQAA, the manager said We have a service user guide which is written in English, Arabic and is available in DVD format. This is good practice and means it is accessible to more people. Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: In the AQAA, the manager also said, All service users have an assessment prior to admission which is completed by CTLD. (Community Learning Disability Team) Part of the assessment looks at parent/carer needs and aims at addressing their needs as well as those of the service user. We looked at pre- admission assessments for some people. We saw that peoples needs are assessed before they start to use the service. This means that staff can be told about any specific needs they might have and know what help and support to provide. The assessments involve the person using the service, their family and any other professionals involved with their care. For example, community nurses or staff from day centres. This is good practice and means peoples needs are identified well. The home offers respite care as well as a service for people who live there permanently. Views were mixed on how well this works and how well this meets peoples needs properly. One person who uses the service said, They are alright the respite people, we get on well, they are friends. Staff said it can be unsettling for some with things changing all the time for people. Other staff said they thought the people who lived at the home on a permanent basis enjoyed the diversity of having different people using the service. In the AQAA the manager told us she is working with the senior managers and people who are responsible for planning the service to look at possible alternatives to the home continuing to provide respite care. She said at the visit that this had been discussed at senior management meetings. Care plans and risk assessments for people who use the service for respite care are not as up to date and detailed as those of the people who live there permanently. Some people who have respite care are unable to carry on with routines and care practices they are used to. For example, there is no space for storage of equipment that a person may use at home. All of this could lead to peoples needs not being properly met. A health professional said that they felt people who use the service for respite are slotted in. And the effects of this on people depends on who is in the home for respite care, for example, staffing levels being sufficient and effects on peoples behaviour. The manager told us that when planning peoples stays, they try to make sure people who are friends or have similar interests can visit at the same time. Care Homes for Adults (18-65 years) Page 14 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people are encouraged to make decisions about their lives and are involved in planning their care and support as much as they can be. This could be extended if greater emphasis was placed on making sure the people who use the service for respite care have the same involvement. Evidence: In the AQAA, the manager said, Service user care plans are comprehensive and based on the person centred approach. All of our service users have an annual review which aims to identify service users changing needs and wants, from this review a care plan is devised. The review includes parent/carers, other service providers, professionals involved in the service users life and key worker from Rix House. She also said that some people who use the service have had person centred plans completed with the assistance of an external agency. When asked what they could do better, the manager said, We could seek to ensure more of our service users have a person centred plan completed by an independent agency. Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: We looked at care plan and risk assessment records for some people who live at the home. We found the care plans to be person centred and individual to each person. Care plans and risk management plans had clear and detailed instruction on how the needs of people who use the service are to be met. Staff said they felt the care plans gave them enough detail on meeting peoples needs. One said, They were so useful when I first started work here. One of the staff has been trained in person centred planning to assist people with planning their care, support and future hopes and dreams. The manager said some other staff have received training in person centred approaches to enable them to focus their care planning on people as individuals. We also looked at care plans and risk assessment records for people who use the service for respite care. We found these to have a number of shortfalls which could lead to peoples needs being overlooked. The plans were not dated or signed by the person who had completed them. Therefore it was difficult to say if they were current. They did not give detailed directions for staff on peoples care and support needs. Terms such as total care and hoist do not accurately describe peoples care needs. Risk assessments had not been completed when it was clear that people were at risk. For example, from choking, falls and pressure ulcers. However, staff were familiar with peoples care needs and could talk confidently about the support they give. They had good knowledge of peoples individual support needs and could describe peoples routines and any associated risks well. Care plans are reviewed at least annually or as peoples needs change. For people who use the service for respite care, the service does not routinely contact parents or carers to discuss any changes. They rely on parents or carers giving them that information. For example, changes in mobility or medication. Some consideration should be given to reviewing peoples needs prior to every visit so that any changes are not missed or overlooked. People are encouraged to make choices and decisions about what they do. Staff said they encourage people to make choices in their every day lives such as what to do, where to spend their time, what and where to eat, what to wear and where to go out. We saw people being offerred choices throughout the visit. Staff respected peoples choices and also responded well to requests for anything from the people at the home. One person wanted a particular staff member to make their coffee as they said they make the best coffee. We saw people were supported to make choices, using a variety of communication methods such as pointing, signing, touch and facial expression. People who use the service have regular meetings. We looked at the minutes of these. Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: They are produced in an easy word and picture format to make them more accessible to people. In the AQAA, the manager said, Service users meetings are held every other month. During the meetings service users are encouraged to express their views about the home and any changes they would like to see, they are encouraged to respect other peoples point of views, and help to advocate for service users who have communication difficulties or who are less confident. The manager gave us some good examples of what has changed in response to listening to people who use the service. She said they had changed the ways in which holidays were organised, giving people more choices and opportunities and had reorganised the staff rota to suit peoples individual needs better. She also said they had made changes to the homes environment to make it more homely. Care Homes for Adults (18-65 years) Page 17 of 38 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 adequate 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 make some choices about their lifestyle. In the main, social, educational, cultural and recreational activities meet peoples expectations. They also benefit from a good, healthy and varied diet, but improvements could be made to make the setting in which they are eaten more comfortable and pleasing for people. Evidence: In the AQAA, the manager said, Most of our service users attend day time activities 5 days per week which is provided by day services. Those who wish to stay at home are accommodated with their wishes. We have entertainment facilities such as T.V. DVDs, music systems, and often have activities taking place such as art and craft, dominoes, jigsaws and bingo. We have a comprehensive garden where we grow plants, flowers vegetables and salad. Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: People said they really enjoyed the bingo nights. One person said, Its great, we have really good prizes. On the day of our visit a number of people went out in the evening to a disco in the local community. People were supported to get ready for the social event and clearly enjoyed getting dressed up for the occasion. Staff said they had enough staff to provide a decent level of activity for people, both in the house and out and about in the local community. Activity on offer within the service includes, a multi sensory room, listening to music, watching television, jacuzzi baths, board games and arts and crafts. A new interactive games console had also just been bought in response to a suggestion made by people who use the service. We saw lots of pictures around the home showing activities people were involved in such as days out to places of interest and the coast and holidays. Staff said they use the local community facilities such as shops and pubs for people who use the service. However, there were periods of time when people who use the service looked bored and received very little staff interaction other than if they were being offerred food, medication or personal care. Some people, especially those who do not use verbal communication and are wheelchair users were sat in front of the television for long periods of time yet it was not clear if they wanted to be there. On looking at one of these peoples socialisation plan it said they usually like to listen to music at this time. We also noted that the size and layout of the building does not lend itself to adequate supervision, especially at busy times, of people who live at the home and could lead to the situation described above. Most of the time though, social interaction between staff and people who use the service was good. It was clear that staff and people who use the service get on well. We asked the manager how the service had improved in the last year. She said the following: We have increased the number of staff who can drive the minibus and larger people carriers so increasing the number of days out and visits to the Theatre. We have identified new social clubs and increased the number of social nights out We have increased our staffing levels and changed our rotas to facilitate service user outside activities We have had our menus approved by the dietician who has stated they are nutritional, well balanced and appealing. In the AQAA, the manager said, Service users are encouraged to partake in the Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: planning of meals which are planned on a three monthly menu. Special diets for medical/religious/cultural reasons are caterd for and there is a choice from three meals at each setting. If service users do not wish to choose anything from the days menu they are welcome to request an alternative. Service users are offered drinks and snacks throughout the day and can request staff to get them a drink or snack anytime. We looked at menus at the home. These are planned around peoples likes and dislikes. They looked varied and healthy. Staff said people can always have an alternative to what is being cooked if they dont like it and snacks are readily available if people ask for them. People said they liked the food. One person said, Its always beautiful. However, records were not always being completed of the food people eat and people who are nutritionally at risk do not have care plans to say how this is managed. Staff were confused as to what a persons dietary needs were and whether they were keeping a food intake record. This inconsistency could lead to care needs being missed or overlooked. A health professional said, High standards of food provision. Staff are positive/considerate towards service users in their cultural/religious beliefs and helping them make choices by having a picture menu. We observed the tea time meal in the dining room. Food is served on the plate from the kitchen serving hatch and distributed by staff to the tables. The meal time was not well organised or neither did it seem to be a time for people to relax, socialise and share a meal. People were arriving at the tables in a random way. Some people had finished their meal and left the table before others had sat down. Some people were given bread and butter to go with their meal but no plate to put it on. People who needed help to eat their meals had to wait until everyone else had been served. One person was assisted by two different staff for their meal as staff had to leave to attend to medication. The radio was put on but no-one was asked if they wanted this on. No efforts were made to assist people to help themselves to food, there were no tureens or serving dishes on the table to encourage peoples independence. There were however jugs of juice and tea and coffee and it was clear that people enjoyed helping themselves. Some consideration should be given to increasing opportunities for personal development of peoples independent living skills, especially at mealtimes. The way meal times are organised should also be reviewed to make them a more relaxed and social occasion. Care Homes for Adults (18-65 years) Page 20 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples general healthcare needs are, in the main, met and based upon their individual needs. They must however, be monitored better. Medication administration systems need to be more robust to ensure peoples needs are properly met. Evidence: In the AQAA, the manager said, Staff support service users with their personal hygiene based on the needs and wants of the service user and in compliance with the care plan. All personal care is carried out in privacy with due cognicence to dignity and respect. Staff strive to provide service users with the choice of who works with them i.e. same gender/culture. Each service user has their own key worker and support worker who aims to build a positive and trusting relationship with the service user. Despite the gaps in care planning as mentioned in the individual needs and choices section of this report, staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live or stay at the home looked well cared for, well dressed and groomed. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: The manager also said in the AQAA, We have a very good relationship with our GP surgery. All of our service users are offered support to attend GP appointments, though are encouraged to manage their own medical treatment if able to do so. If specialist health care is required the staff team will work closely with the professional and if necessary undertake training in order to ensure the needs of the service user is met. Good records are kept of health appointments and their outcomes. Staff make sure that people are given support to attend appointments to meet their health needs. People are referred to health professionals when needed. For example, dieticians, occupational therapists, physiotherapists and specialist nurses. A health professional said that staff follow any guidance or instruction on health needs ably and willingly. Another said, Rix House provides a professional service, all staff are friendly and willing to help. However, on the day of our visit, records showed that a person who uses the service had been showing some signs of ill health for a number of days and yet no medical assistance had been requested. Records did not show what action was being taken to address this matter and it was not clear how this persons health issues were being handed over to staff each day. It did not appear that anyone was taking responsibility for the overall monitoring of this persons health needs. On bringing the situation to the managers attention she said a doctors appointment would be made the next day for this person. We also noted that it was identified as part of someones moving and handling assessment in June 2009 that they needed new slings for the hoist. Records did not show if a referral for these had been made and no-one knew if the new slings had been provided. There was no system in place to check follow up on referrals made. Staff said they had received some training on meeting the specialist health needs of people who use the service such as epilepsy, diabetes and nutritional needs. The manager said further training is planned on autism and dementia. Staff also said they had been trained in medication administration and handling. We looked at medication and medication records. The home uses a monitored dosage pre-packed system for medicines for people who live permanently at the home. There are good ordering systems in place. We checked some medication administration records (MAR) sheets. We found there were a number of errors with medication administration. There were medications that had not been signed for, so it was unclear if they had been given. These were pointed out to the manager who said they would be investigated. We also noted that some people who receive as and when needed Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: medication did not have guidelines in place as to when it should be given. This could lead to inconsistencies and needs being missed or overlooked. Medication for people who use the service for respite care is booked in as people arrive and a MAR sheet is handwritten. This is not checked or countersigned by a second person to make sure it is correct. We noted that a MAR sheet had been written up by staff for someone but they had failed to write down the dose of the medication which could have led to erorrs in administration. This was rectified at the time of our visit. Care Homes for Adults (18-65 years) Page 23 of 38 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 adequate 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 but are not always fully protected from abuse. Evidence: In the AQAA, the manager said, We listen to all service users and visitors concerns and complaints and actively encourage people to record their complaints, preferably in writing so that they can receive a reply within 2 days. We take all complaints and concerns seriously. All complaints are attempted to be resolved at a local level but if this is not possible they are then passed to our complaints manager. If a person wishes to make a complaint but is not aware of the procedure or do not feel able to complain without support we will put them in touch with the PALS (Patient Liason) officer and an advocacy agency. The manager said they had not received any complaints since our last visit to the service. We have not received any concerns about the home. People who use the service or their relatives said they knew what to do if they were unhappy about anything. People said they would tell their keyworker or the manager of any complaints. There is an easy read complaints procedure displayed in the home. The manager said they make people aware of this by individual discussion with them or discussion at house meetings. Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: In the AQAA the manager said that staff were familiar with safeguarding adults procedures and knew how to refer matters to the local authority. Records showed that staff had received training in safeguarding adults. However the records were not clear when staff had undertaken this training as part of their induction. The manager said she would make sure they were properly updated to reflect this. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. There have been a number of safeguarding adults incidents in the service since the last inspection. These have been reported and acted upon. However, on looking through the homes incident reports, it came to light that there have been a number of further incidents of physical abuse that have occurred between service users. Each incident is recorded in the home but has not always been referred to safeguarding adults for investigation or passed on to CQC. The manager said she had not done this when safeguarding adults were already aware of the situations through previous referrals and situations were already under investigation. We pointed out that each incident must be referred so that peoples situations can be monitored properly and protection plans updated if needed. The manager agreed to make sure all the incidents were reported and referred. We also found that an incident where a person using the service had made an allegation about a staff member that had not been reported to safeguarding adults. Again the manager explained that this person already had a protection plan in place regarding such matters. However, the risk assessment relating to this person had been changed by the staff and not by agreement with safeguarding adults. This does not protect the person or the staff properly. The manager agreed to update safeguarding adults on this situation and to fully review the risk assessment. Safeguarding adults procedures must be followed fully at all times for all allegations or incidents of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. Records are kept of the finances of people who live at the home and their monies are kept safe. Care Homes for Adults (18-65 years) Page 25 of 38 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. Overall, the environment is homely, comfortable and safe for people who live at the home. Evidence: In the AQAA, the manager said, We strive to maintain a safe homely environment for all of our service users. All service users have their own single room which they encouraged to personalise and choose their own furniture, ornaments and decorations. The ground floor is accessible for wheelchair users and several of the rooms have overhead tracking. When asked what had improved in the service, the manager said, We purchased new pictures, ornaments and soft furnishings to make the communal areas more homely. We display service users art and craft work. We have brightened up our dining room by purchasing table cloths and table decorations. We now have monthly cleaning audits which are completed by the hotel services department. We had a look round the home. Communal areas, bathrooms and bedrooms were visited. The home looked clean, homely and in the main, well maintained. Most people who use the service said it was always clean and fresh. One person said Cleanliness could be better at times. Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: The home is accessible to anyone using a wheelchair. There is specialist equipment such as tracking hoists and hi-lo beds and baths which means they can meet peoples diverse needs. There is also a multi- sensory room, that is well equipped to meet peoples needs. People have key fobs to enable them to lock their bedroom doors if they want to. The manager said they carry out an assessment of peoples ability to manage a key fob. If they are unable to do so staff manage the security of their room for them. On the ground floor there is a large communal sitting room. This is well set out and decorated and furnished in a modern style. There is also an additional sitting room/conservatory/dining area where people who use the service can entertain visitors. Part of the building upstairs has been made into a flat for four people who use the service. This flat has its own bathrooms and a kitchenette and dining room. As mentioned in the Lifestyle section of this report, the size and layout of the building does not lend itself to adequate supervision, especially at busy times, of people who live at the home and can lead to some people being isolated. Some people were sat alone in the dining room for long periods of time. There is also a lack of storage space in the home for items such as electric wheelchairs and mobile hoists. The manager is currently looking into how this can be improved with the possible addition of outside storage. The environmental health department visited the home recently. The home were awarded five out of a possible five stars from this visit. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. However, the laundry floor is in need of replacement. It is a tiled floor that has many holes and cracks in it, making it difficult to keep it clean. Care Homes for Adults (18-65 years) Page 27 of 38 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 are trained skilled and there are in the main, sufficient numbers to support people who use the service. Evidence: In the AQAA the manager said, We invest in our staff team, ensuring they are the right calibre for the job and that they have the right skills and qualifications for the post. We have a high standard of training for our staff and ensure they have the correct training in order to complete their role to the highest standard. All new staff complete a comprehensive induction course and are entered on to the Learning Disability Induction Award, which they are required to complete within the first six weeks of their employment. When asked how the service had improved, she said, We have increased the number of staff on duty during the morning and late afternoon/evening. We have increased the number of staff who have an NVQ3 in care. We have listened to and acted upon staff suggestions for changing the planning of the rota to ensure better skill mix of staff. A relative said, Extra staff has made a big difference. People who use the service, their relatives and health professionals spoke highly of the staff. Their comments included: Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: We have a great staff team I love the staff here Staff always do their best Staff are doing their best for (name of person) Staff are on the whole very good and do their best. All the staff we spoke to said they felt they had enough staff to meet peoples needs properly. The manager and assistant manager also works flexibly to meet the needs of the service. There are usually 6 staff on the early morning shift, 2 or 3 on during the day depending on who is at home, and 7 on the late afternoon and evening shift. At weekends there are 7 staff on throughout the day. In addition to this there are 2 staff plus a member of staff sleeping in at night, a cook every day and 2 domestic staff Monday to Friday. The manager and asistant manager are not part of these numbers unless they are covering shifts in emergencies. We looked at recruitment records These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. The manager has also involved people who live at the home in interviews for new staff to get their involvement in choosing staff. One person told us how much they enjoyed doing this. Staff said all their training and induction was good and that any updates they needed were always provided. Their comments included: Very good training, they make sure we get what we need Very good when you first start They were aware of new training course such as autism, that are being planned for them. Records showed that staffs essential training such as moving and handling, first aid, conflict resolution and infection control was up to date. The manager has a training plan in place which shows who has done what training and when any updates are due. As mentioned in the complaints and protection section of this report, records on who has completed safeguarding adults training need to be more clearly shown. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: Staff complete an annual appraisal with their manager to identify any training needs or special interests they may have. Well over half of the staff team have completed an NVQ (National Vocational Qualification) in care at level 2 or above. This means they are qualified to carry out their job. We looked at staffs supervision records and saw that regular one to one sessions are provided for staff to discuss their roles. Staff said they were happy with the support they get. One said, We are well supervised and get plenty of opportunities to discuss how we are doing in our job. Care Homes for Adults (18-65 years) Page 30 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is well managed. The interests of people who use the service are seen as important to the manager and staff and are, in the main, safeguarded and respected. Evidence: In the AQAA, the manager said, We have continued to listen to our service users and parent/carers and acted upon their ideas. We have a good working relationship with our service users and parent/carers and we know them well. We strive to give a high standard of care and the staff team are commited to ensuring that the rights, choice, inclusion and independence of our service users are met. We have annual service user feed back questionnaires. The registered manager has many years experience working in management and care services for people with learning disabilities. She has an NVQ 5 in Operational Management and is a Registered Nurse Learning Disabilities, making her suitably qualified to run and manage the home. In addition to this, the assistant manager also has a management and care qualification. Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: Staff and people who use the service spoke highly of the management team. Their comments included: We all like the manager Very professional Manage things well, always chase things up for the benefit of people who live here They try their best for everyone Managers great, very good support Approachable, support us well. The manager and some staff have completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards which has given them a better understanding of the rights of people who use the service, their liberty and decision making processes. In the AQAA the manager said that regular health and safety checks are carried out. Staff confirmed this, saying they have regular checks to identify hazzards and repairs that need doing and fire safety tests are carried out weekly. In the AQAA, the manager also said relevant policies and procedures were in place, and reviewed. She said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. She also said relevant health and safety policies and procedures were in place, and reviewed. Accident records are completed, followed up and monitored for any patterns trends or ways of avoiding future accidents. In the main, the CQC have been informed of these where necessary. However, as mentioned in the concerns complaints and protection part of this report, some on-going issues had not been reported properly to us. The manager is aware this must be done in future. A senior manager from the organisation visits the home to conduct monthly provider reports with requirements for improvement. These should take place on a monthly basis. Records showed there had been some gaps of more than a month in the frequency of these visits. Staff said they speak with people who use the service and staff during these visits as part of their monitoring of the service. Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: The organisation seeks the views of people who use the service or their relatives and health professionals by sending out a questionnaire so that they can get feedback on how people think the service can improve. We looked at some of these that had been returned. They were overall very positive about the service received. However, staff had completed them for some people who use the service who do not use verbal communication. They had used their own judgement of what they thought the person using the service might say about it. This is not an accurate reflection of peoples views. Some consideration should be given to seeking independent advocacy for these people so that their views may be able to be better represented. Care Homes for Adults (18-65 years) Page 33 of 38 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 34 of 38 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 9 13 All risks to people who use the service must be identified and assessed. This is to make sure that practice is safe and peoples needs are fully met. 28/02/2010 2 17 13 Nutritional needs must be assessed and monitored for people who use the service who are nutritionally at risk. This is to make sure their needs are properly met. 28/02/2010 3 19 13 Peoples health care needs 28/02/2010 must be reviewed to make sure they are recieving the support and health care they need. This is to make sure that peoples health care needs are fully met and they get the health care they need at the time that they need it. Care Homes for Adults (18-65 years) Page 35 of 38 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 4 20 13 Guidelines must be in place for the administration of as and when required medication. This is to make sure people are given the right medication when they need it and their needs are not missed or overlooked. 28/02/2010 5 23 13 Safeguarding adults 28/02/2010 procedures must be followed fully at all times for all allegations or incidents of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. 6 30 23 The laundry floor must be 30/04/2010 replaced with a suitable floor covering. This is to make sure it is kept clean and hygienic for people. 7 42 12 The CQC must be notified of any events which affect the welfare of people who use the service. This is to make sure that the health, safety and welfare of people who use the service is protected properly. 28/02/2010 Care Homes for Adults (18-65 years) Page 36 of 38 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 3 Some consideration should be given to reviewing the mix of the provision of both respite care and permanent placements of people at the home. This is to make sure peoples needs are properly met. All people who use the service should have detailed care plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. Some consideration should be given to increasing opportunities for personal development of peoples independent living skills. The way meal times are organised should be reviewed to make them a more relaxed and social occasion. People should be referred promptly for any specialist health care support they need and these referrals should be regularly followed up to make sure they are not forgotton. Handwritten entries on MAR sheets should be checked and countersigned by a second person to make sure the information is correct and people receive the right medication. Visits by or on behalf of the registered provider should take place on a monthly basis to make sure the home is monitored properly and people who use the service have an opportunity to air their views about it. Some consideration should be given to seeking independent advocacy for people who do not use verbal communication so that their views may be able to be better represented when giving feedback on the service. 2 6 3 11 4 5 17 19 6 20 7 39 8 39 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 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) 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. Care Homes for Adults (18-65 years) Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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