Care Home: Safeharbour

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What the care home does well Two people were ``case tracked`` and in each care file there were a variety of care plans that enable staff to determine the needs of each person. Each care plan is an individualised description of what a person`s needs are and how staff are able to support individuals in achieving these on a daily basis. Each person has a ``key worker`` and we saw records that showed that the key workers play an important part in supporting people. Positively care plans celebrated what a person could do and reminded staff of this so that individual`s are able to retain their levels of independence. There are care plans that cover people`s, mobility, personal hygiene, eating and drinking, contact with family and friends and activities. It was also good to see communication plans so that people are able to take part in their care planning and make relevant choices and decisions within their daily lives. We saw photographs and pictures that are used as aids and we were told that some staff are trained in the use of Makaton sign language as some people living in the home are able to sign so that individual choices and decisions can be made. The care plans and risk assessments we looked at matched the care needs described in assessments and we saw that reviews are used to check if things need to be changed. We also noted that care plans are updated promptly when needed; for example, if people should need some support with their behaviour. Plans are put in place, updated as necessary for staff to follow which include strategies to help staff to respond consistently. Information we had from staff discussions and surveys supported the view that people who live in the home are supported to make decisions which are then reflected in their care plans. For example we received a range of comments from staff:`The clients are well looked after assisting where necessary but encourage them to care for themselves`. `Care plans are up to date and service users activities are usually changes to suit the service users needs`. `The home person centred approach and excellent care given to clients`. `Excellent knowledgeable staff team who help each individual work towards their potential`. `Become more familiar with each clients needs to enable us to be even more person centred`. `Perhaps they could look into more activities for the wintertime especially for the clients that find it difficult to bowl or don`t get any interest out of museums`. We saw a variety of risk assessments to make sure people receive the support they require promoting individual`s safety throughout their daily lives are in place where required, such as, fire safety, mobility, behaviour and so on. We did not fully inspect the standards relating to daily life and meals but we were told by staff that meals were varied and nutritious. In the care records we looked at we saw photographs of meals to aid individual`s likes and dislikes. We saw good life histories with photographs so that people are able to take part in this.We also saw in the care records that we looked at that people enjoy a varied range of activities. These included, personal shopping, room care, bowling, sauna, activities, arts and crafts, recycling, places of interest, making breakfast and so on. The AQAA told us what the home does well in reference to meeting people`s social stimulation and interests:`Service users are able to take part in age, peer and culturally appropriate activities. Choice/need led activities are provided between 9.00a.m. and 6.00p.m. And evening activities offered to each individual. Service users are encouraged and supported to have regular family contact. Service users are supported to use all forms of public transport. Service users are part of the local community. Service users are encouraged to use local amenities as part of activity plans. Service users have appropriate personal, family and sexual relationships. Actively support service users to have contact with family and friends. Each service user has `Maintenance of family relationships` care plan. Service users rights are respected and responsibilities recognised in their daily lives. Service users are supported by people that know them well and will understand an individual`s rights and responsibilities. Safeharbour as a whole is managed by a team that understand that service user`s rights are paramount. Service users are offered a healthy diet and enjoy their meals and mealtimes. Service users are provided with meals that their carers have observed and documented that they like`. The AQAA also referred to what could be improved upon:`Introduce people that live here to a wider range of experiences and activities. Help individuals to cope with new experiences. Find more venues and social events to offer opportunities to socialise with others. Support individuals to cope with obsessions about food and lifestyle`. Surveys received from people who live in the home told us:`Lovely food. Nice rooms. Lots to do`.`Listen to what clients want and see to my needs`. `Learn more about me so that staff can support me to do more activities`. `Maybe go on holiday with my carers. I would also like to socialise with other people besides my carers or family`. People`s medical conditions are drawn up in their care records with plans and information in place for staff to follow in relation to epilepsy. We saw that staff help people to go to see their doctor and other people if they are unwell or need a check up. This should make certain people`s health is promoted and any risks are noted to inform effective staff practices. There are medication plans for ``as required`` medications which ensures staff have the necessary guidelines for people who take these particular medications. Therefore although we did not inspect the administration and handling of medicines at this visit we can see that staff are provided with clear and effective guidelines to promote people`s health and wellbeing. Also we were told that ``Boots`` pharmacist had visited the home recently to audit medications and there were no requirements that arose from this. We, the Commission had received a complaint from a relative and we referred them to the funding authority as it was concerning a person who used to live at the home. We did discuss this with the manager and we were assured that the manager and staff had done all that they were able to do which was in the persons best interest at the time. We discussed with the manager whether they had rec What the care home could do better: We were not able to look fully at the admission process to make sure that this is followed for all new people who come to live at the home as the people who live in the home have lived there for some time now. However, we were shown the statement of purpose and service user guide. These are information guides that tell people what it would be like to live at the home and what facilities are offered. Both the statement of purpose and service user guide needs some updating so that all of the information supplied is relevant and does not mislead people. We saw one person`s hospital passport but these could not be found in any other care records we looked at. It is important that each person living at the home has hospital passports/health action plans as they make sure they get all the support they need to stay healthy and well. Also these are able to be transported with the person to any health appointments and hospital admissions. The actiing manager acknowledges that this is an area that needs to be worked on. Weight records showed that staff are not always regularly checking people`s weight to ensure they are not losing or gaining a significant amount of weight that could be an indicator of an underlying health needs. This is particularly essential for people who have limited communication, understanding and or may not be able to consistently express if they are unwell. The acting manager acknowledged that people`s weights need to be checked regularly and has developed a book to ensure that tasks are completed by staff.It is recommended that a spreadsheet or chart covering staff training and development should be set up. This should show (for each member of staff) training completed and qualifications gained (with dates), gaps in training including ``refreshers``, and dates when outstanding training is to be delivered. It was suggested that doing this could provide the manager with an effective tool for monitoring and updating the training and development needs of the staff team. We are aware from the AQAA that the manager intends to, `Continue to ensure the team are appropriately trained in; equality and diversity, LDQ (Learning Disabilities Qualification) and Infection Control`. The AQAA tells us that the former acting manager has recognised the areas which they are looking to improve upon and should be followed through by the new acting manager in the next twelve months and some of these are:`To continue to review individuals needs and choices on a regular basis. Introduce the people that live here to new experiences and activities. Explore social opportunities for the individuals that live here. To ensure that all professionals involved in the care of service users know them individually. Continue to maintain and improve each individuals Person Centred Plan. Review all policies concerning Personal Healthcare and Support. Training ``Vulnerable Adult`` booked for 22nd March 2010. Provide more training in Infection Control, Health and Safety, Food Hygiene. Develop individual training plans for each member of the team. Continue with training schedule. Review all Safeharbour Policies and Procedures regarding staffing. Develop individual training plans for each member of the team. Continue with training schedule. Review all Safeharbour Policies and Procedures regarding staffing`. Random inspection report Care homes for adults (18-65 years) Name: Address: Safeharbour 52 Corbett Avenue Droitwich Spa Worcestershire WR9 7BH three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Seel Date: 0 1 0 4 2 0 1 0 Information about the care home Name of care home: Address: Safeharbour 52 Corbett Avenue Droitwich Spa Worcestershire WR9 7BH 01905796214 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) : Dr Anjani Kumar,Mr Geoffrey Moultire Copeland care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 6 The maximum number of service users who can be accommodated is: 6 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 categories: Learning Disability (LD) 6 Date of last inspection Brief description of the care home Safeharbour is situated in a quiet residential area within a short distance of Droitwich Spa town centre and a wide range of local amenities. The premises are in keeping with the environment and the local community. There is a small patio area at the rear of the house but no garden. Accommodation is provided on two floors and all the residents have their own single bedroom. The home provides a service for six people with learning disabilities who have high support needs. Care Homes for Adults (18-65 years) Page 2 of 12 Brief description of the care home Information about the service is available from the home on request. The fee for the service range between one thousand nine hundred and two thousand eight hundred pounds per week. Additional charges are made for personal services such as hairdressing and personal items such as clothes and toiletries. Care Homes for Adults (18-65 years) Page 3 of 12 What we found: The purpose of the visit to the home was to complete a random inspection as the last key inspection of the home was undertaken on the 14th August 2007. Excellent outcomes for people were reported at this key inspection and this random inspection was to review the standards of care being provided to ensure that the health and welfare of people who live in the home continues to be actively promoted. This random inspection was undertaken by one inspector who visited the home over four hours no prior notice being given to the manager or staff at the home. We did not look at all the standards at the time of this random inspection. On the day we visited the home five people were living there. The home provides care and support for people by the reason of a learning disability. Discussions with people living at the home were not appropriate on the day we visited due to the short amount of time we spent at the home and being unfamiliar to people who have various communication needs. During the visit we case tracked two people who live in the home. This involves discovering their experiences of living at the home by looking at their care records and speaking with staff, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. We also looked at three staff files, training records, reviewed the homes complaints procedures and spoke with the new acting manager of the home about any changes that may have taken place within the home since we last completed a key inspection. The former acting manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the former acting managers comments have been included within this inspection report. We also received completed survey forms from three people who use the service and seventeen staff working at the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. We acknowledge that the current acting manager was new in post the week we visited but they have worked at the home for abut six years and were promoted from a team leader position to acting manager. Therefore the acting manager is now completing their six month probationary period where they will be supervised within their new role. We provided the acting manager with some feedback at the time of our visit and have summarised below what the home does well together with what they could do better. We have also made four good practice recommendations at the end of this report which should be considered to make sure people who live in this home are continuing to receive excellent outcomes. What the care home does well: Care Homes for Adults (18-65 years) Page 4 of 12 Two people were case tracked and in each care file there were a variety of care plans that enable staff to determine the needs of each person. Each care plan is an individualised description of what a persons needs are and how staff are able to support individuals in achieving these on a daily basis. Each person has a key worker and we saw records that showed that the key workers play an important part in supporting people. Positively care plans celebrated what a person could do and reminded staff of this so that individuals are able to retain their levels of independence. There are care plans that cover peoples, mobility, personal hygiene, eating and drinking, contact with family and friends and activities. It was also good to see communication plans so that people are able to take part in their care planning and make relevant choices and decisions within their daily lives. We saw photographs and pictures that are used as aids and we were told that some staff are trained in the use of Makaton sign language as some people living in the home are able to sign so that individual choices and decisions can be made. The care plans and risk assessments we looked at matched the care needs described in assessments and we saw that reviews are used to check if things need to be changed. We also noted that care plans are updated promptly when needed; for example, if people should need some support with their behaviour. Plans are put in place, updated as necessary for staff to follow which include strategies to help staff to respond consistently. Information we had from staff discussions and surveys supported the view that people who live in the home are supported to make decisions which are then reflected in their care plans. For example we received a range of comments from staff:The clients are well looked after assisting where necessary but encourage them to care for themselves. Care plans are up to date and service users activities are usually changes to suit the service users needs. The home person centred approach and excellent care given to clients. Excellent knowledgeable staff team who help each individual work towards their potential. Become more familiar with each clients needs to enable us to be even more person centred. Perhaps they could look into more activities for the wintertime especially for the clients that find it difficult to bowl or dont get any interest out of museums. We saw a variety of risk assessments to make sure people receive the support they require promoting individuals safety throughout their daily lives are in place where required, such as, fire safety, mobility, behaviour and so on. We did not fully inspect the standards relating to daily life and meals but we were told by staff that meals were varied and nutritious. In the care records we looked at we saw photographs of meals to aid individuals likes and dislikes. We saw good life histories with photographs so that people are able to take part in this. Care Homes for Adults (18-65 years) Page 5 of 12 We also saw in the care records that we looked at that people enjoy a varied range of activities. These included, personal shopping, room care, bowling, sauna, activities, arts and crafts, recycling, places of interest, making breakfast and so on. The AQAA told us what the home does well in reference to meeting peoples social stimulation and interests:Service users are able to take part in age, peer and culturally appropriate activities. Choice/need led activities are provided between 9.00a.m. and 6.00p.m. And evening activities offered to each individual. Service users are encouraged and supported to have regular family contact. Service users are supported to use all forms of public transport. Service users are part of the local community. Service users are encouraged to use local amenities as part of activity plans. Service users have appropriate personal, family and sexual relationships. Actively support service users to have contact with family and friends. Each service user has Maintenance of family relationships care plan. Service users rights are respected and responsibilities recognised in their daily lives. Service users are supported by people that know them well and will understand an individuals rights and responsibilities. Safeharbour as a whole is managed by a team that understand that service users rights are paramount. Service users are offered a healthy diet and enjoy their meals and mealtimes. Service users are provided with meals that their carers have observed and documented that they like. The AQAA also referred to what could be improved upon:Introduce people that live here to a wider range of experiences and activities. Help individuals to cope with new experiences. Find more venues and social events to offer opportunities to socialise with others. Support individuals to cope with obsessions about food and lifestyle. Surveys received from people who live in the home told us:Lovely food. Nice rooms. Lots to do. Care Homes for Adults (18-65 years) Page 6 of 12 Listen to what clients want and see to my needs. Learn more about me so that staff can support me to do more activities. Maybe go on holiday with my carers. I would also like to socialise with other people besides my carers or family. Peoples medical conditions are drawn up in their care records with plans and information in place for staff to follow in relation to epilepsy. We saw that staff help people to go to see their doctor and other people if they are unwell or need a check up. This should make certain peoples health is promoted and any risks are noted to inform effective staff practices. There are medication plans for as required medications which ensures staff have the necessary guidelines for people who take these particular medications. Therefore although we did not inspect the administration and handling of medicines at this visit we can see that staff are provided with clear and effective guidelines to promote peoples health and wellbeing. Also we were told that Boots pharmacist had visited the home recently to audit medications and there were no requirements that arose from this. We, the Commission had received a complaint from a relative and we referred them to the funding authority as it was concerning a person who used to live at the home. We did discuss this with the manager and we were assured that the manager and staff had done all that they were able to do which was in the persons best interest at the time. We discussed with the manager whether they had received any complaints and we were told that they had not which was also stated within the AQAA. We saw that there is a complaints book that can be used to record any complaints so that this can be reviewed and an audit trail of actions taken with resolutions where required. Completed surveys from six people gave us the following information, two people said the staff always listen to them and act on what they say with two stating, usually. Also in response to, Is there someone you can speak to if you are unhappy, all three said yes. In answer to, Do you know how to make a formal complaint; all three people stated yes. It was noted that staff said they had received training in the protection of vulnerable adults from abuse. They were also able to show their understanding of relevant issues and of the importance of reporting any incident of actual or suspected abuse. We looked at three staffing files and found that all the relevant employment checks are in place to ensure that people living in the home are protected from people who are banned from working with vulnerable people. We were told by some staff that relationships between all staff are improving and they are working better as a team. It was good to hear that as in the staff surveys that we received there were some mixed comments about, staff morale being low, favouritism amongst some staff, improve on communication and more seniors. We did discuss staffing issues with staff when we visited and it would appear that staff are now working better has a team. On a positive note staff were able to recognise what difficulties had arisen within the staffing group. Also what action was required to ensure people who live in the home are fully supported by an effective staff team. Some of the other staff Care Homes for Adults (18-65 years) Page 7 of 12 comments we received were:Work as a team support each other. Safeharbour senior staff and management are always helpful if we have a problem always willing to try and make our shift go well for staff and residents. In my opinion Safeharbour stands out in terms of management and quality of care it provides to individuals first class. The Annual Quality Assurance Assessment (AQAA) shows that 14 staff are trained to NVQ level 2 or above, and that training provided meets national standards and statutory guidelines. We did not fully inspect staff training but staff that we spoke with said that they were up to date with their mandatory training, such as, infection control, health and safety, medications and first aid. We are aware from the AQAA that, Team members trained in the specific needs of the individuals; autism, epilepsy, challenging behaviour, breakaway techniques. The AQAA also informs us that 19 staff out of 21 full time care staff have received training in infection control. We also saw that staff meetings are taking place where the specific needs of people who live in the home are discussed and staff are able to share any concerns and or complaints they have within a collective forum if they wish. Also without exception the staff that we spoke with confirmed that they find their supervision to be a supportive process. These processes enable staff to share any issues they may have to ensure that the home is run in the best interests of people who live there. What they could do better: We were not able to look fully at the admission process to make sure that this is followed for all new people who come to live at the home as the people who live in the home have lived there for some time now. However, we were shown the statement of purpose and service user guide. These are information guides that tell people what it would be like to live at the home and what facilities are offered. Both the statement of purpose and service user guide needs some updating so that all of the information supplied is relevant and does not mislead people. We saw one persons hospital passport but these could not be found in any other care records we looked at. It is important that each person living at the home has hospital passports/health action plans as they make sure they get all the support they need to stay healthy and well. Also these are able to be transported with the person to any health appointments and hospital admissions. The actiing manager acknowledges that this is an area that needs to be worked on. Weight records showed that staff are not always regularly checking peoples weight to ensure they are not losing or gaining a significant amount of weight that could be an indicator of an underlying health needs. This is particularly essential for people who have limited communication, understanding and or may not be able to consistently express if they are unwell. The acting manager acknowledged that peoples weights need to be checked regularly and has developed a book to ensure that tasks are completed by staff. Care Homes for Adults (18-65 years) Page 8 of 12 It is recommended that a spreadsheet or chart covering staff training and development should be set up. This should show (for each member of staff) training completed and qualifications gained (with dates), gaps in training including refreshers, and dates when outstanding training is to be delivered. It was suggested that doing this could provide the manager with an effective tool for monitoring and updating the training and development needs of the staff team. We are aware from the AQAA that the manager intends to, Continue to ensure the team are appropriately trained in; equality and diversity, LDQ (Learning Disabilities Qualification) and Infection Control. The AQAA tells us that the former acting manager has recognised the areas which they are looking to improve upon and should be followed through by the new acting manager in the next twelve months and some of these are:To continue to review individuals needs and choices on a regular basis. Introduce the people that live here to new experiences and activities. Explore social opportunities for the individuals that live here. To ensure that all professionals involved in the care of service users know them individually. Continue to maintain and improve each individuals Person Centred Plan. Review all policies concerning Personal Healthcare and Support. Training Vulnerable Adult booked for 22nd March 2010. Provide more training in Infection Control, Health and Safety, Food Hygiene. Develop individual training plans for each member of the team. Continue with training schedule. Review all Safeharbour Policies and Procedures regarding staffing. Develop individual training plans for each member of the team. Continue with training schedule. Review all Safeharbour Policies and Procedures regarding staffing. 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 2. Care Homes for Adults (18-65 years) Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 10 of 12 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, 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 1 1 Consideration given to updating the statement of purpose and service user guide so that all of the information provided is reliable. To consider developing health action plans/hospital passports for the other residents who currently do not have these in place to help ensure proactive health prevention arrangements are in place in all areas and these are portable. The recording of individuals weights needs to be completed in a consistent manner so that any losses and or gains in a persons weight is identified in a timely manner to make sure there are no underlying medical conditions which would otherwise go undetected. A training matrix should be developed in order that the manager can monitor that suitable numbers of staff have up to date training to meet residents needs. 2 19 3 19 4 35 Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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