Care Home: Rother Heights

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What the care home does well The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The staff team want to make sure that the people who live in the home receive good care. Staff showed a good understanding of what each individual likes and dislikes and we saw staff use a number of techniques for communicating with the people using the service. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 People being cared for have good access to professional medical staff and are able to access external services such as dentists, specialist nurses, GP`s and consultants, so their health is looked after and they are kept well. We saw that the majority of people living in the home were out and about during the day, attending school, doing activities and spending time with the staff and others using the service. There is a good range of social opportunities available to people and the home has sufficient staff on duty to ensure individuals are able to take part in stimulating and interesting activities, both in the home and community. What has improved since the last inspection? The medication practices in the home have changed, we found on this visit that staff follow professional guidelines and keep people well and safe from harm. Staff training has got better and includes mandatory safe working practice such as fire, moving and handling, first aid, food hygiene and health and safety as well as good range of subjects that relate to looking after people with learning disabilities. So staff have the skills and knowledge to deliver a high standard of care and meet the needs of people living in the home. What the care home could do better: The manager and staff have worked hard to meet the requirements of the previous report (27 August 2008). We have made no new requirements in this report, but there are some recommendations focusing on best practice guidelines which the service should try to meet. We would like to thank everyone who spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Key inspection report CARE HOME ADULTS 18-65 Rother Heights Rother Crescent Treeton Rotherham S60 5QY Lead Inspector Eileen Engelmann Key Unannounced Inspection 10th December 2009 09:30 Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 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. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 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 Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Rother Heights Address Rother Crescent Treeton Rotherham S60 5QY 0114 229 3450 0114 269 2786 rotherheights@autismcareuk.com autismcareuk.com Autism Care (UK) Limited 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) Alix Lisa Shinkins Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Learning Disability - Code LD, maximum number of places 24 The maximum number of service users who can be accommodated is: 24. 27th August 2008 Date of last inspection Brief Description of the Service: Rother Heights specialises in the care of people with autism. The home is on the edge of a residential estate in the Treeton area of Rotherham with open views over the countryside. It is a purpose built single storey development comprising four houses and an administration block in secure and spacious gardens. Each of the four houses has six single bedrooms with en-suite showers and toilets, a lounge, dining room, sun lounge, kitchen, laundry room, bathroom and toilets. Doors have guarded hinges to prevent trapped fingers, under floor heating is fitted and toughened glass is used in windows. Heating and lighting is computerised and can be adjusted to suit people’s individual needs. There is ample car parking space for visitors. The Statement of Purpose, Service User Guide and other information were displayed in the reception area of the administration building. Information given to us on 10 December 2009 by the manager indicated that fees were from £1,900 to £6,500 per week. Hairdressing and toiletries were charged extra. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2* stars. This means that the people who use this service experience good quality outcomes. Information has been gathered from a number of different sources over the past 16 months since Rotherheights was last visited by the Care Quality Commission, this has been analyzed and used with information from this visit to reach the outcomes of this report. This unannounced visit took place with the manager, staff and people using the service. The visit included a tour of the premises, examination of staff and peoples files, and records relating to the service. Staff interactions with people using the service were positive with staff talking and interacting readily with individuals. People were relaxed in their home and appeared comfortable. Due to the specific communication needs of the majority of the people using the service, no formal discussions were held between them and the inspector. One person kindly showed us around their bedroom and we chatted to three people who were in their houses, we also spoke briefly to staff who were on duty during our visit. Questionnaires were sent out to a selection of people living in the home, relatives and staff. At the time of this visit these had not yet been returned to the Care Quality Commission. The manager was asked to complete an Annual Quality Assurance Assessment (AQAA) and return this to us by the 29 December 2009. As a consequence the inspector did not have the completed document at the time of this visit. 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. What the service does well: The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The staff team want to make sure that the people who live in the home receive good care. Staff showed a good understanding of what each individual likes and dislikes and we saw staff use a number of techniques for communicating with the people using the service. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 6 People being cared for have good access to professional medical staff and are able to access external services such as dentists, specialist nurses, GPs and consultants, so their health is looked after and they are kept well. We saw that the majority of people living in the home were out and about during the day, attending school, doing activities and spending time with the staff and others using the service. There is a good range of social opportunities available to people and the home has sufficient staff on duty to ensure individuals are able to take part in stimulating and interesting activities, both in the home and community. 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. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 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 Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 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): Standards 2 and 3 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. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: Three people’s care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission. In each of the three care plans looked at during this visit there was a copy of the community care assessment and Local Authority care plan. The home also completes their assessment of need and from these a detailed and descriptive care plan is developed. Input from other professionals and/or family is also recorded and each plan is individualised to the person using the service. Information given to us through discussion with the manager during our visit, is that wherever possible individuals thinking about moving into the home, are encouraged to visit the service on several occasions to meet the staff and other people living in the home, before making the decision to come in Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 9 permanently. Where a person is unable to visit the home the manager or senior staff will meet with them before they are admitted so they see a familiar face when they come into the service. Discussion with the manager indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. A number of people using the service have serious communication problems, but we observed staff and individuals interacting in a positive manner and staff used a number of different techniques to ensure people were listened to and their choices acted on. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 10 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): Standards 6, 7 and 9 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. The health, personal and social care needs of the people living in the home are being met by the service and staff; and people using the service have confidence in the staff looking after them. EVIDENCE: The care of three people was looked at in depth during this visit and included checking of their personal care plans. Each individual using the service has a detailed care plan, which identifies each persons needs and abilities, choice and decisions and likes and dislikes. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. Reviews of care with the families, person living in the home and care coordinator from the local authority are taking place and minutes of these Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 11 meetings are in the plans. One person whose care we looked at has had a Best Interest Meeting carried out regarding the home obtaining a Guardianship order for the individual. Best Interest meetings take place when informed choice cannot be made by the individual and includes the views of all those involved in the individuals care. Included in the care plans is a ‘Person Centred Plan (PCP), which some people using the service have been actively involved in writing. The PCP contains the views, opinions and choices of each person about their care and how they wish to be looked after. People have ‘Health Action Plans and Traffic Light documentation in their care plans, that is taken with them if they are admitted to hospital; this contains up to date medical information about individuals and ensures that important information is passed to relevant health professionals involved in diagnosis and treatment of people using the service. It also gives important information about the specific behaviours of individuals and how to manage these safely. Staff enable people to take responsible risks in their every day lives and information within the care plans includes a number of risk assessments covering activities of daily living, use of equipment and personal safety information. The care plans clearly describe any restrictions (agreed with the person using the service) and the reasons for these. Information from the staff training matrix given to us on 10/12/09, shows that staff have had limited training provided around equality and diversity, deprivation of liberty and the mental capacity act. This knowledge and information is used to ensure that peoples choices and human rights are maintained and that any limitations on facilities or personal choice are only made following assessment, best interest meetings, risk assessments and discussion with the person concerned or their representative. The registered person should ensure that this training is given to all staff so that they can ensure people’s rights are understood and protected. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 12 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: Standards 12, 13, 15, 16 and 17 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. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. They can access and enjoy opportunities in their local community such as public transport and the local shops. EVIDENCE: At the time of our visit (December 2009) there was one person accessing full time education and three people who attend a local community centre to do a computer course each week. One individual goes to a gardening and woodworking placement and others are being assessed for this course. The home has a mini-bus and a people carrier for transporting people in and around the community and staff undergo robust tests before they can drive these vehicles. Recent trips out include visits to the sea-side, bowling and shopping. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 13 One person attends church on a weekly basis and enjoys going to the church group, a number of other people attend Gateway which is a learning disabilities club doing social activities each week. Some of the people living in the home are able to go on holidays with the staff; individuals have recently gone to Lincolnshire, Butlins and Denby Dale. Where people are not able to go on extended visits away from the home, there are lots of days out arranged by the staff. The manager told us that there is flexibility in the staffing rota, to enable more outings and time spent on social events to take place. Individuals each have their own activity schedule in their care plan; which details their interests and hobbies. We saw that a number of people were going out with members of staff to do activities and attend appointments during our visit. Walking around the home we observed staff spending 1-1 time with individuals. Regular activities include walks in the community, horse riding, reflexology, hydrotherapy at a local facility and attending swimming classes held in the local leisure centre. The manager told us that the weekly fees include a set amount for activities and enables people to take part in a number of different groups and sessions. Information in the care plans we looked at, showed that relatives keep in touch through telephone calls, visits and e-mails. The manager said that in the summer months the home holds a number of open days where family and friends are able to visit and take part in social activities. The majority of those using the service have contact with relatives, individuals are able to spend weekends at home (where wished) and one individual is spending Christmas with their family. There are monthly house meetings for people using the service, where they can discuss any issues they have and make choices about outings, meals and other aspects of the service. Recent feedback was that people wanted somewhere quiet to go in the houses, so the staff have used empty bedrooms to provide additional lounge space and ‘time out’ areas. Two people go to a self-advocacy group in Sheffield and, where appropriate, some individuals attend and participate in the staff meetings held in the home. The manager told us that plans are in place to develop an in-house newsletter which would be service user led. This should be up and running by March 2010. Bedroom doors are supplied with simple locks and the staff respect the fact that people need time alone or with their family. There are few individuals using the service who can verbally communicate their wishes to people, so a variety of aids are used to enable better communication between staff and people. We saw that some individuals have information boards outside their rooms to show them what is happening during their day, and picture boards are used in the kitchens to indicate what people would like to eat. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 14 Meal times at Rotherheights are very relaxed and people can eat when and where they wish. The main meal of the day is in the evening and this is the only time that individuals are expected to sit down and eat together. The main meal is from a set menu, but during the day people can choose what they want to eat by using pictures to indicate their choices or by choosing items from the kitchen cupboards. People living in the home only go into the house kitchens under staff supervision and where able they can make their own sandwiches, drinks or snacks with staff help. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 15 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): Standards 18, 19 and 20 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. Peoples personal and healthcare needs are met through good inter-agency working and by the staff having a sound knowledge of each individuals needs. Staff ensure that personal support is flexible, consistent and is able to meet the changing needs of the people using the service. EVIDENCE: It was apparent from discussions with the staff that they were knowledgeable about peoples preferences and likes/dislikes regarding their care. Information, within the care plans looked at, shows that each person has their own preferred daily routine including their choices and wishes regarding care giving. Information in the care plans and discussion with the manager indicated that the service encourages individuals to develop their skills in carrying out personal hygiene. Staff offer help and support with teeth brushing, bathing, washing, dressing and toileting, but wherever possible individuals are encouraged to do this for themselves. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 16 People in the home are able to access health care through the local GP, mental health team, epilepsy specialist nurse and dentist amongst others who provide support and advice for the staff when needed. Staff have attended training around epilepsy awareness to help them meet the needs of people using the service. Information in the care plans shows that individuals are receiving visits from health care professionals and support plans are in place to deal with their medical conditions. Individuals have their Health care plans and traffic light information to take to hospital if they need to be admitted; these contain up to date information about the person which ensures diagnosis and treatment is more efficient. For those people unable to give informed consent for treatment, a Best Interest meeting is held to ensure the best possible outcome for the individual. Minutes of these meetings are kept in each persons care plan. At our last inspection on 27 August 2008 we made a requirement that ‘To keep people safe from medication errors staff must follow safe practices when dealing with people’s medication. This must include satisfactory record keeping and storage procedures’. Checks during this visit found the requirement has been met. The home uses a local pharmacy to provide the medicines to people using the service. There are information sheets in the medication records telling staff about the different types of medication in use and further advice on how each individual person likes to take their medication. Checks of the medication records showed that these are up to date and completed to an acceptable standard. We checked the Controlled Drugs and the Controlled Drugs Register in each of the four houses within the service. For three of the houses these were up to date and correct, but one house (Fence) had recorded one medication in the register incorrectly. The amount of medication was correct but staff had put the quantity given into a column for medication destroyed. The deputy manager said that she would ensure the entry was corrected immediately. We found that none of the four houses has an appropriate Controlled Drugs cabinet. Discussion with the manager indicated that four new cabinets have been requested and would be installed by 22 December 2009. We found that medication to be returned to the pharmacy was kept in the same cabinet as medication currently in use. This is due to a lack of storage facilities in each office, and could lead to mistakes being made in the medication administered to people. We recommended that additional storage cabinets are obtained for each office to enable staff to keep medications in use, Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 17 and those to be returned in separate cabinets. Also the staff must keep oral medications and those to be used in other ways (creams, lotions and rectal medicines) in separate cabinets to ensure no errors in administration are made. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 18 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): Standards 22 and 23 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. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. EVIDENCE: Checks of the records show that there have been no formal complaints made about the home or its service since the last key visit on 27 August 2008. There is a good complaints system available and on display within the home, which support the people living in the home or their representatives to be able to raise any concerns and be confident that these will be dealt with appropriately. The complaints system is made up of two complaints policies. The first is a comprehensive policy, which has been developed by the service and is available to anyone who wishes to have a copy. The second is an easy read version, which allows for clear direction if anyone, in particular a person using the service, wishes to complain. At our last visit in August 2008 we made a requirement that ‘The providers must make sure staff undertake adult safeguarding training to raise awareness and ensure people are protected’. Checks at this visit found the requirement has been met. The staff demonstrated a good awareness of the process to safeguard the people in the home from abuse. The staff training matrix we looked at Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 19 indicated that staff have received training on protection of adults from abuse, and five have attended Mental Capacity Act briefings. We recommended that all staff attend training around the Mental Capacity Act, Deprivation of Liberty safeguards and equality and diversity issues and that this becomes part of the homes rolling programme of staff development/training. No referrals have been made under the Protection of Vulnerable Adults procedure since the last key inspection in August 2008. Appropriate policies and procedures are in place in relation to the protection of the people using the service. The manager informed us that all staff undergo a twelve week induction programme when they start work; this includes Learning Disabilities training which looks at Autism and has a number of different units for staff to work through. Staff are trained to use NAPPI techniques, there are three levels of training and staff are trained to level 3 which includes using approved restraint methods on individuals displaying challenging behaviour, which may cause harm themselves or others. We found that staff record any physical interventions on appropriate forms and these are kept in the individual care plans. Copies of the forms are sent to the service’s head office and are analysed by the trainers, to see that staff are using the correct techniques in appropriate circumstances. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 20 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): Standards 24 and 30 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. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles. EVIDENCE: Rotherheights is a purpose built facility, consisting of a five single storey buildings. One building is used for administration and also has a staff training room within it. The other four buildings are called ‘houses’ by the service and are named Vale, Fence, Sorby and Mill. Entry to the grounds is through an electronic gate, with a key pad at the side of the gate or admission from the administration staff. There is a large car park to the side of the building for visitors and staff, and open grounds around the home with fenced boundaries. There are key pad locks on the gates between the houses for the security and safety of people using the service. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 21 Each house has six single bedrooms, each provided with an en-suite shower/bathroom and toilet facilities. People living in the house share a good sized lounge and sun room. There is a separate dining area and supervised access to a domestic type kitchen. There is a laundry room with washing, drying and sluicing facilities, and there is a communal bathroom. Each house has an office with lockable storage for records and medication cabinets. Staff have separate sleeping-in rooms within each house. There is an ongoing maintenance programme within the home, at the time of our visit the laundry facilities in the four houses were having new washing machines and dryers fitted, to improve the service offered. Two bedrooms were also having repairs carried out to the en-suite floors. Staff support people using the service to do their own laundry wherever possible, and everyone is encouraged to put their dirty clothing to wash each day. Care staff have attended Infection Control Training and have access to aprons and gloves when doing laundry or personal care. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 22 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): Standards 32, 34 and 35 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. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. EVIDENCE: At the time of our visit there were eleven people using the service, a mix of six male and five female residents in the home and an appropriate mix of staff as well. So individuals have a choice of who looks after them. Observation of the interactions between staff and people using the service showed that staff are skilled in communicating and interpreting the needs of the people who live in the home. Checks of the staffing rotas show that each of the houses is separately staffed. Vale has four staff per shift and at night there is one waking and one sleeping staff member. Fence has 2 staff on duty day and night and an extra 10 hour shift to cover peak times. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 23 Mill has two staff on duty day and night and an extra staff member during the middle of the day to enable people to attend activities. Sorby has three staff on during the day and two at night Eleven service users receive 1-1 funding and the rota’s show staff who is responsible for which person’s care. Checks against the residential staffing forum guidelines for a ‘younger adults’ home shows that the service is meeting the minimum recommended staffing hours. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. All new members of staff undergo a twelve week induction programme, which includes Learning Disabilities training. There is a rolling programme of mandatory safe working practice training and additional specialist subjects linked to the complex needs of those with Autism. At our last inspection on 27 August 2008 a requirement was made that ‘The providers must make sure staff receive the relevant training to ensure that people’s individual needs can be met, e.g. Epilepsy awareness’ Checks of the staff training matrix provided by the manager at this visit, showed that this requirement has been met. The staff training matrix indicates that only two members of staff have completed an NVQ. We recommend that at least 50 of staff achieve this award by the end of January 2011. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 24 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): Standards 37, 39 and 42 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. The manager is supported well by senior staff in providing clear leadership throughout the home, with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager of the service is Alix Shinkins, she came into post after the last inspection in August 2008 and she has completed her registration with the Care Quality Commission. She has prior management experience in looking after those with autism or a learning disability. The home does not have a formal Quality Assurance System in place but there are robust checks in place to ensure the service runs smoothly and meets the Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 25 aims and objectives written in the Statement of Purpose. The manager and her deputy carry out monthly audits of the service and this includes analysis of any accidents, incidents or complaints. Personal allowances for people using the service were checked and cash tallied with the records. The registered person visits the home each month and completes the Regulation 26 report for the service. The manager sends out satisfaction questionnaires to the staff, relatives, people using the service and healthcare professionals on a yearly basis, as part of the home’s quality assurance process. She is aware of the need to produce an annual development plan based on the systematic cycle of planning-action-review, which reflects the aims and outcomes for service users. At our last visit to the service on 27 August 2008 we made a requirement that ‘To ensure the health, safety and welfare of people living in the home: Arrangements must be made for staff to undertake training and demonstrate competency in mandatory health and safety training (i.e. moving and handling, basic food hygiene, emergency or first aid, infection control and fire awareness) Weekly checks of fire equipment must be undertaken Regular fire drills must be arranged to ensure that staff are fully conversant with the procedures’. Checks at this visit showed the requirement has been met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed risk assessments for a safe environment within the home. Risk assessments were seen regarding fire and daily activities of living. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 26 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 3 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 2 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 2 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 2 x 3 x 2 x x 3 x Version 5.3 Page 27 Rother Heights DS0000071502.V378619.R01.S.doc 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. 1 Refer to Standard YA7 Good Practice Recommendations The registered person should ensure that all staff receive training around equality and diversity, deprivation of liberty and the mental capacity act. So staff have a good understanding of people’s human rights and that any limitations on facilities available or personal choices are only made following assessment, best interest meetings, risk assessment and discussion with the person concerned or their representative. The registered manager should ensure that staff receive refresher training around recording within the Controlled Drugs Register. The registered person should ensure there is sufficient storage space provided to keep specific medications separate from each other and prevent the risk of errors occurring. The registered manager should ensure that at least 50 of the care staff has achieved an NVQ 2 by the end of January 2011. DS0000071502.V378619.R01.S.doc Version 5.3 Page 28 2 3 YA20 YA20 4 YA32 Rother Heights 5 YA39 The registered person should ensure that there is an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for service users. Rother Heights DS0000071502.V378619.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. 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