Care Home: Shandon

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What the care home does well The service provides a relaxed, friendly, happy and homely environment. Staff were observed to be caring, respectful and attentive to people`s needs throughout. A person living in the service said, "The staff are nice and i am happy here". Health care professionals surveyed said, "The service provides a real "Home" which is caring for its residents". "The staff understand my clients needs very well and provide an excellent standard of care". "The service creates a relaxed environment which responds well to my service user`s needs and "They are very professional to their clients and very caring". Each person has a detailed and comprehensive care plan in place,which clearly identify peoples likes, dislikes, choices and preferences for support. People are supported to access and take part in the local community such as using local facilities and being members of the church. People are supported to take part in household activities including cleaning, choosing their meals and one person said that they like making cakes. What has improved since the last inspection? The statement of purpose has been reviewed and the kitchen has been refurbished. What the care home could do better: No requirements were made as a result of this inspection. Two good practice reccomendations were made. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shandon White Lane Ash Green Hampshire GU12 6HN     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: Lisa Johnson     Date: 2 8 0 4 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 Older People 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 Older People Page 2 of 26 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 Older People Page 3 of 26 Information about the care home Name of care home: Address: Shandon White Lane Ash Green Hampshire GU12 6HN 01252312801 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 Pamela Mary Eales care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users to be accommodated is 4. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Shandon is one of several Registered Care Homes owned by Just Homes. The home is registered to accommodate a maximum of four adults with learning disabilities. The home is detached and situated in a quiet residential road. Local facilities and amenities are close by. The garden area is attractive and well maintained. The home provides a caring and supportive service and encourages individuals to participate in activities and live an independent lifestyle. The current ranges of fees are £1,533.06-£6,272.09 Care Homes for Older People Page 4 of 26 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was part of a key inspection, which took place over five hours commencing at 9:40 am. Mrs. L. Johnson carried out this visit. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment(AQAA). This is a self assessment that focuses on how well outcomes are being met for people using the service. Reference is made to this document throughput this report. During this visit we met with two people who live in the service, two members of staff and the organisations service manager. Care Homes for Older People Page 5 of 26 We received two surveys from people who use the service who had been supported to complete these. We also received two surveys from care managers and two from health care professionals. Comments received are reflected in this report. During this visit we carried out a tour of the premises, we looked at care plans and risks assessments, medication administration practices, menus, staff personnel and training records and sampled policies and procedures. The inspector would like to thank the people living in the the service and staff for their time, assistance and hospitality in carrying out this visit. 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 Older People Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People are provided with information,which they need to know to make an informed choice about the suitability of the home as a place to live. Peoples needs are assessed prior to admission to the home. Evidence: The home provides a statement of purpose and service user guide. Some of the information including contracts and the complaints procedure has been adapted in accessible format. We were informed that other areas of the document are to be developed using pictures or makaton symbols. We were informed that this information is reviewed annually. Information supplied in the AQAA states that people referred to the service receive an assessment prior to admission to the home. This was confirmed by information seen on the file of the most recent person admitted to the home,which covered their health, Care Homes for Older People Page 9 of 26 Evidence: personal, emotional, emotional, social, participation and cultural needs. Other information had also been obtained from the care manager, health care professionals and family. Care Homes for Older People Page 10 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People receive support from staff in they way they prefer and want and their physical and emotional needs are met. People are protected by the homes medication policies and practices Evidence: Each person has a plan of care in place. During this visit we looked at three peoples care plans,which were detailed and comprehensive and provided clear information and guidelines to staff about peoples health , personal, emotional, and social needs and how their needs are to be supported. We were informed that the service is intending to implement care plans which will be more accessible to people with the provision of pictures. Information supplied in the AQAA states that care plans are reviewed six monthly and that a weekly meeting takes place between people and their key worker. Daily diaries are maintained,which reflect peoples goals. It was seen that some of the information in peoples files would benefit from being reorganised to make the information easier to read, however the manager had Care Homes for Older People Page 11 of 26 Evidence: identified this as an area for improvement in the AQAA. It was clear that peoples likes, dislikes, choices and preferred routines are recorded and respected such their preferred times of going to bed and getting up. One persons plan identified that they like to have a cup of tea in bed before getting up in the morning. During this visit staff were observed to be caring and respectful to people and a health care professional surveyed said, The home is very aware and proactive in ensuring peoples privacy and dignity. Each persons care plan contained risk assessments ensuring that they are are kept safe. One persons care plan identified that they require assistance with moving and handling. A member of staff spoken with was clear about the procedure for safe handling and using the hoist, which was documented in their care plan. Another persons care plan identified that they need support when mobilizing with their walking frame. staff were observed to follow these guidelines during this visit. Peoples weights are monitored regularly and risk assessments and guidelines were in place for supporting people with epilepsy. People are supported by a range of health professionals including, General Practitioner, district nurse, chiropody, dentist, occupational therapist, physiotherapist and a person diagnosed with dementia is supported by the community learning disability team. Records were maintained of all health consultation visits. Information provided in the AQAA states that the home with the community team for people with learning disability have provided support to one person to overcome their fear of attending medical appointments. Two health care professionals surveyed said, The service is very professional and have a good system for health care and they are excellent to work with;They are very aware of my clients health care needs and meet them accordingly and The service provides a real home, which is caring for its residents and the the staff understand my clients needs very well and they give an excellent standard of care. During this visit we looked at the homes medication administration practices. Medication was stored appropriately and systems are in place for the receipt and auditing. Medication is dispensed using the monitored dose system (MDS) and the local pharmacy carries out audits. Each person has a medication profile and medication administration records included a photograph of the person for identification and they were all signed. Care Homes for Older People Page 12 of 26 Evidence: Approval had been obtained for the administration of homely remedies, although it was observed that some people were receiving vitamin supplements which were recorded separately. It was not clear whether written authorisation had been obtained by the General Practitioner, therefore the service is advised to pursue this. Staff receive medication administration training, although it was recommended that a list of staff who are trained and authorised to administer medication should be kept with the medication filerecords. Care Homes for Older People Page 13 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferences, social, cultural, religious and recreational interests and needs are met. People maintain contact with their family , friends , representatives and the local community. people are supported to exercise choice over their lives and are provided with varied and well balanced meals. Evidence: Each person living in the service has a weekly activities programme, which meets their needs and preferences. Daily diaries are maintained of all activities that are completed. People have life books, which contain photos and information about peoples histories. their interests and hobbies. During this visit one person had left the home to attend day services. This person also attends a community group where they participate in shopping, cooking and computing. Another persons care plan identified that they enjoy doing knitting The home has their own accessible vehicle and people participate in shopping trips, visiting the pub and restaurants going the cinema and visiting the theatre. People living in the service are supported to attend church and maintain links. Care Homes for Older People Page 14 of 26 Evidence: The home holds social events such as inter house activities such as bowling competitions and Halloween party. People maintain links with their family and friends who are invited for social gatherings such as firework party and Christmas tea. One person has a friend who lives in another home whom they visit . Information seen in peoples care plans recorded how people are to be supported to make choices such as their preferred clothing and daily activities. People are supported to participate in household activities including bedroom cleaning, hoovering and dusting and meal preparation. One persons care plan identified that they like to make their toast for breakfast and another person told us that they like making cakes and were seen assisting making tea during this visit. A health professional surveyed said, My client is able to make some decisions, which are always respected by the provider. During this visit good relationships were seen between people and staff who were interacting throughout and enjoyed their lunch together. The home provides a very relaxed and homely environment and they also have a cat called Sparky. The home maintains a comprehensive menu folder showing the planned meals for the following week. People are very much involved in menu planning and each day a member of staff will support a person to place the menu in pictorial format so that everybody is aware of the days meal. Menus were observed to be varied and well balanced. During the lunchtime meal sensitive support was provided by staff,which provided a relaxed and unhurried atmosphere. Care Homes for Older People Page 15 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. If people have concerns they or people close to them know how to complain. and people are safeguarded from abuse Evidence: The home has a complaints procedure which has been adapted into service user friendly version and a copy was seen on display in peoples bedrooms. We were also informed that this is provided to prospective people in the service user guide and copies have been provided to peoples families. Since our previous visit the home has not received any complaints and no complaints or concerns have been brought to the attention of the Commission. Information supplied in the AQAA states that that people living in the home are unable to to complain formally, but they are able to say if they are unhappy. A person spoken with during this visit said, The staff are nice, kind and i am happy here and a person surveyed said, The staff are very good and i am happy where I live. A health professional said, My client is very happy in this environment. The home had a safeguarding vulnerable adults from abuse procedure, although the up to date local authority procedure was not available. We were advised that the organization is in process of sending this out to them. Staff receive safeguarding training and two members of staff spoken to confirmed this, who were clear in their Care Homes for Older People Page 16 of 26 Evidence: responses about types of abuse and their responsibilities should they ever witness or be made aware of any incident where the safety of a person is compromised. Since our previous inspection there have been no matters referred following the local authority procedures Care Homes for Older People Page 17 of 26 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, 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. 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. People live in a safe, well maintained, comfortable and clean home. Evidence: The service provides a homely environment, which was well maintained, decorated and furnished to a good standard. There is a comfortable sitting room and separate kitchen/diner that has been refurbished There is a large, accessible, well maintained garden to the rear of the property for people to enjoy which had potted plants which people have been involved in planting. People have comfortable and attractive bedrooms,which reflected their gender and were personlised to their preference. A new person who had moved into the home was provided with the opportunity to choose the colour scheme for their bedroom. We were informed that planning permission is still in place from the local council to add an extension to the rear of the property. The home is accessible to people using wheelchairs,which has been provided with ramps. Call systems are in place and specialist equipment has been provided for one person including a profile bed and bathing chair. Care Homes for Older People Page 18 of 26 Evidence: During this visit the home was observed to be clean and hygienic. Cleaning schedules are in place and separate laundry facilities are available. Infection control procedures are in place and we were informed that infection control is included as part of staff health and safety training. However staff were advised to provide disposable towels and liquid soap in the downstairs wash room,which was completed during this visit. Care Homes for Older People Page 19 of 26 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Peoples needs are met by trained and competent staff that are appropriately supervised and they are protected by the homes recruitment policies and practices. Evidence: Three people currently reside in the service and during this visit we sampled the staff duty rota,which indicated that people are supported by two members of staff one of whom works a mid shift. This was confirmed by the numbers of staff seen on duty at the time this visit. At night time people are supported by a waking night member of staff. Where extra support may be required arrangements are in place for staff to attend from other services within Just Homes close by, which was recorded on the rosta. On call management arrangements are also in place should staff require advice and support. The staff rosta was also seen on display in the kitchen with staff photographs to assist people in identifying who is on duty. New staff receive comprehensive induction, which was confirmed by staff spoken with and information seen on staff files, which is based on the Skills for Care core induction standards. Fifty percent of staff have gained National Vocational Qualifications (level) or above. Staff are supported to receive training and development including statutory and Care Homes for Older People Page 20 of 26 Evidence: specialist training. Staff spoken with and training records sampled confirmed that they have received training in safeguarding vulnerable adults from abuse, food hygiene, moving and handling, first aid and health and safety. All statutory training is currently in the process of being updated. One person was identified as having completed training in epilepsy and the manager has recently completed a course in activities for people with dementia and we were informed that arrangements are being made for staff to receive dementia awareness training. Future training has been planned in the mental health capacity act and staff receive equality and diversity training. Comments received from health care professionals included, The staff team are very keen to learn and expand on their skills and In my experience working with a range of staff has been positive. Recruitment is based on equal opportunities and during this visit we sampled three members of staff recruitment files, which contained the required information including an application form, two written references, protection of vulnerable adult first check(POVA) and enhanced criminal record bureau checks(CRB). Staff files also contained job descriptions and a member of staff showed us a copy of the General Social Care code of conduct (GSCC), which provides information to staff about their responsibilities when working in a social care setting. Staff are also provided with a handbook. Staff spoken with during this visit told us that they receive regular formal supervision with the manager, which was confirmed by records viewed. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 home is well run in the best interests of people living there and their wellbeing, health and safety is protected Evidence: Since our previous visit the registered manager is no longer in post and a new manager has been appointed who is yet to be registered with us who has had management experience in other Just Home services. The manager is supported by two senior support workers. Information supplied in the AQAA states that the manager is intending to commence the National Vocational Qualification (level 4) in management. The manager was not available during this visit but we had the opportunity to speak with the organisations service manager. Staff spoken with during this visit said that there is good team work, that management is supportive, accessible and that regular team meetings take place. Monthly quality monitoring meetings are conducted and the written reports were Care Homes for Older People Page 22 of 26 Evidence: maintained in the home for viewing. The home has a system in place for gaining the views of visitors to the home and regular consultation meetings take place to seek the views of people living in the service. We were informed that feedback surveys are carried to gain the views of people, relatives and other stakeholders, although the information for the most recent surveys was not available at the time of this visit. Information supplied in the AQAA states that peoples monies are managed by the manager and records of peoples incomes and expenditure are kept and receipts retained and match the records kept. The service has a range of health and safety procedures and environmental risk assessments are conducted. Water temperature monitoring is recorded and accident/incident records are maintained. Information supplied in the AQAA indicates that routine servicing and maintenance of equipment is up to date, which was confirmed by records sampled. Care Homes for Older People Page 23 of 26 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 Older People Page 24 of 26 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 1 2 9 33 It is recommended that a list is maintained of all staff that are trained and authorised to administer medication. It is recommended that the outcomes of feedback surveys are maintained in the home to be available for inspection. Care Homes for Older People Page 25 of 26 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). 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