Care Home: Ryan Q.C. Homes, The Elms

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What the care home does well When a person feels they may wish to move into the home, staff carry out an assessment of their needs. This information is then used by the manager at the home to see if staff have the skills and experience to provide care for that person. This means staff at the home have very clear information to make a decision on whether they will be able to meet that persons needs. People living at the home have many opportunities to develop and pursue their individual likes and interests. If a person wishes to they can be involved in an activity or pursuit everyday. Staff support them to access local amenities and to be part of the local community. People living at the home are also consulted in how they receive care and support and in how the home is run. People living at the home decide what meals are provided for example. What has improved since the last inspection? Medication systems have improved since the last inspection. We looked at all the medication at the home and all the records about this. The amount of medication was correct and the record keeping was good. This means that people receive their medication when they should. What the care home could do better: We did not make any requirements at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ryan Q.C. Homes, The Elms 10 Repton Court The Arbours Northampton NN3 3RQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Ryan Q.C. Homes, The Elms 10 Repton Court The Arbours Northampton NN3 3RQ 01604411858 01604499720 laurierqch@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Margaret Laurie Duggan care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 There is currently one Service User within the category of LD. By agreement there will not be any further admissions of Service Users under the age of 30 years. Date of last inspection Brief description of the care home The Elms is one of two homes run by Ryan Q.C. Homes and provides personal care for up to three young adults who have learning disabilities. The home is situated in a culde-sac in a residential area of Northampton and is indistinguishable from neighbouring houses. The home is a bungalow with all bedrooms single occupancy. Care Homes for Adults (18-65 years) Page 4 of 27 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: two star good 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 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out on the 12th January 2009. The care of two people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the Care Homes for Adults (18-65 years) Page 5 of 27 individual rooms. Observations of care practise and communication between the people living at the home and staff was also made at the inspection. The managements submission of documentation was also considered prior to the site visit. The focus of this inspection was to look at the key standards. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 27 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 8 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The system in place for staff to assess the needs of prospective people is sufficient to ensure that they would have the information to know if they would be able to meet their needs. Evidence: The statement of purpose was seen to be displayed in the home. The document provided information on the staffing, accommodation and services available at the home. The use of pictures and signs had also been used to assist people to understand the information within the document. As previously assessed there have been no new admissions to the home since the last inspection, the individual plans of care for existing residents evidenced that people have comprehensive assessments to ensure that the service is able to meet the needs of the prospective resident. There was evidence that residents are able to visit the home, view the facilities meet other residents and staff before deciding if they would like to live there. Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: The service has comprehensive admission policies and procedures to ensure that residents admissions are managed appropriately and that residents have information to help them make informed decisions about the home. There is currently one vacancy and the management are mindful of the need to ensure that any new resident is able to integrate well with the existing residents. Each resident has a contract on file which specifies the terms and conditions of residency. Care Homes for Adults (18-65 years) Page 10 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning systems are good and mean staff have sufficient information to ensure all people receive continuity of care. Evidence: At the time of this inspection a leak had just caused a flood into the area used to store records. Staff had moved everything, however one of the care files had been damaged. Staff had drawn together emergency information to replace the main folder for this person, they had acted promptly and in the best interest of the person. Two people were case tracked both had an individual plans of care which provided detailed instruction to staff about all aspects of persons health, personal and social care needs. There is evidence that these are developed with the person and that their views are sought about how they wish to be cared for. In addition the manager advised that further development was planned to make further improvements. As reported at the previous inspection there was evidence that any restrictions placed Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: on people are in their best interests and that appropriate risk assessments were in place to support these decisions. Individual plans of care contain information about the management of challenging behaviour and provide detailed instruction to staff about how these behaviours are to be managed. Documentary evidence was seen that both the residents and their families are consulted about the content of the individual plans of care and that the residents have access to a key worker. Individual plans of care contain detailed information about how the residents are to be involved in making decisions within their daily lives such as times of rising and retiring to bed and choice of activity. Outcomes for residents were good for example there is a file, which contains pictorial information about available activities that is used to enable residents with limited communication to make decisions about what they would like to do. There is also evidence that residents are able to choose to opt out of activities should they wish to do so. The individual plans of care contain detailed and comprehensive risk assessments pertaining to the residents activities and daily lives, appropriate controls are in place to maximise independence and yet maintain the persons safety. Care Homes for Adults (18-65 years) Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social, religious and recreational interests are effectively promoted in accordance with their known lifestyles and given capacities. Evidence: Care records contained information to show people have access to educational opportunities through attendance at college and one to one tuition in basic life skills. People living at the home also are able to attend local day centres where they are able to pursue their individual likes and interests. People also access the local community through use of local shopping and leisure facilities such as going to pubs and restaurants and getting take away meals. People are supported to maintain their faith should they wish to do so and are able to receive their chosen visitors to the home. Residents are also supported to visit family Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: members and to celebrate seasonal and family events such as birthdays. As previously assessed Individual plans of care are person centred and promote the equality and diversity of the individual. They are produced in easy read formats to maximise the residents access to information that is recorded about them. Routines appear to be flexible within the constraints of planned activities. The staff are mindful of the residents privacy and were seen to knock and await permission prior to entering residents rooms. The staffing arrangements ensure that there is always a female carer on duty to provide intimate care for female residents. Risk assessments are in place regarding the absence of privacy locks on bedroom doors and there is evidence that residents have been consulted about their wishes regarding this. Individual plans of care demonstrated that residents are supported to manage their personal mail and that appropriate risk assessments are in place. Staff were seen to relate well to residents and to address them by their preferred name. Residents were able to confirm that the staff were nice to them. The menu was viewed and options available provided a balanced diet through the provision of three meals a day with snacks and drinks in between. There is the option to have a cooked breakfast at weekends and a roast dinner is provided, the food is home cooked. Residents meet on a weekly basis to plan the menu, their food preferences are well documented in the individual plans of care. There is evidence that residents are involved in the preparation of food according to their wishes and capability. Residents have access to appropriate aids and adaptations to promote their independence. Care Homes for Adults (18-65 years) Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication systems and the accessing of health-care mean people receive the care that they need to maintain a satisfactory level of well being, Evidence: As previously assessed and demonstrating sustained compliance, individual plans of care contained detailed instruction to staff about the a persons wishes in the way that they are cared for and preferred routines. There was comprehensive and detailed instruction to staff about personal care such as presentation, hair care, oral care and nail care. The Staffing mix continues to be reflective of the residents age, gender, race and culture, existing residents are both white British with English as their first language. Residents have access to a wide range of health care specialists such as General Practitioners, specialist nurses, Speech and Language Therapists, Community Learning Disability Teams and hospital services. There is evidence that residents have routine health checks such as eye tests and Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: visits to the dentists. Medication was managed well and stored appropriately. Medication is obtained from a high street chemist in a monitored dose system with associated Medication Administration Records. Records and stocks examined showed that these were all in order and people had received their medication when they should have. Care Homes for Adults (18-65 years) Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training of staff is sufficient to ensure they have a satisfactory level of understanding of the safeguarding protocols to protect the people living at the home. Evidence: There have been one complaint about this service since the last inspection and this had been looked into by the local authority. Feedback to us was that the concern that had been raised had not been upheld. As previously assessed the service has a comprehensive complaints policy and there are complaint leaflets available in the main entrance. Residents and their relatives are able to make complaints about the service should they wish to do so. Information about the complaints policy is also included in the Statement of Purpose and welcome pack supplied to new residents. As previously assessed records examined at this inspection show that staff had undertaken training in the safeguarding of vulnerable adults. Through a previous safeguarding referral made by the home, staff have demonstrated a good level of knowledge on the types of abuse including physical and psychological. In addition the homes procedure in this area was examined, it reflected the local guidance. The service supports residents to manage their own money; this was not checked on this occasion due to the circumstances of the flood. Limited staff have access to residents money and associated records to ensure accuracy and accountability. The Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Manager confirmed that in her absence residents could access money from the petty cash. Care Homes for Adults (18-65 years) Page 18 of 27 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. The level of cleanliness and decor is good and provides people with a pleasant environment in which to live. Evidence: These were as assessed at the previous inspection. The premises are suitable for their stated purpose, being a large bungalow within a residential setting. The premises are well maintained; the garden areas are accessible and safe. No hazards were identified; fire doors are fitted with automatic closure devices. The premises are clean, well ventilated, heated and have appropriate lighting, there are adequate supplies of hot water. Residents have access to a large lounge, dining room with an additional conservatory, all facilities are located on the ground floor and are accessible to wheelchairs. Furnishing and fittings are of a domestic nature and provide residents with a homely and comfortable place to live. Each person has their own bedroom, these are fitted with wash hand basins, bath and shower rooms are in close proximity. Bedrooms are appropriately furnished and evidence that residents are able to personalise their rooms and have their own Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: possessions around them. There was also evidence that residents are involved in decisions about the decor of the home. A leak from a pipe that had caused water damage had been managed proficiently. Through the actions of the manager and staff there had been no disruption to the people living at the home. Care Homes for Adults (18-65 years) Page 20 of 27 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 systems have been effective to ensure that all staff have the needed levels of competency to keep people safe at all times Evidence: As previously assessed staffing levels appear to be adequate to meet the needs of the existing residents. There is one sleeping member of staff on duty at night and at least one carer on duty during the day; extra staff are available for activities and outings as required. Examination of staff files to look at recruitment practises showed this area to follow national guidance. It was noted that the files contained proof of identity; verification of employment history and that Criminal Records Bureau clearance had been obtained. The system that had been followed was noted to be thorough when recruiting staff. Observation of the support given by staff to people during the visit was made. Conversation flowed freely between them and it was noted that staff used different forms of address for each person. Training records seen, showed staff had undertaken statutory training. The files could still be accessed even though the flood had occurred, the manager was very helpful. Care Homes for Adults (18-65 years) Page 21 of 27 Care Homes for Adults (18-65 years) Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are sufficient to reduce the risks associated with this area for the people living at the home Evidence: The Registered Manager is qualified, experienced and competent to manage the service. There is a deputy manager in post and a deputy manager form another home within the group. In addition the manager was in the process of appointing a new Area Manager, this person would oversee the day to day running of the home and look at making improvements and continue the development of the service. Health and safety records were reviewed and found to be in good order with routine checks being conducted on a regular basis. Certificates were also available to demonstrate that the fire alarm systems, electrical, gas and emergency lighting have been serviced as required. There was also evidence that appropriate kitchen records were being maintained to Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: ensure that fridges and freezers are maintained at safe temperatures. Appropriate risk assessments are in place for individual residents and for the environment and accident records are maintained. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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