Care Home: Sheldon Ridge Nursing Home

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What the care home does well People who live at the home seemed comfortable and relaxed in their surroundings. People`s relatives said they were pleased with the choice of this home. Their comments included: "Things are great here" "Couldn`t have chosen anywhere better" "Always very welcome, feel like part of the family" "Atmosphere is much improved these days". People`s relatives said they were involved in the drawing up of the care plans. Comments included: "We feel listened to" "They ask us about the care plans and invite us to meetings" "We feel fully involved in (name of person`s) care". People who live at the home looked well cared for, well dressed and groomed. Relatives also told us they were very happy with the standards of care at the home. Their comments included: "More than happy with (name of person`s) care" "She can dress herself and do more for herself since being here" "They always provide staff who are familiar with (name of person) and know her care plans." Relatives of people who use the service spoke highly of the staff. They said, "Staff are wonderful with (name of person)" "Staff attend to all (name of person`s) needs, even get clothes specially made for them" "Big improvement with staff since Lisa (current manager) came in, they are more confident" "Staff`s skills are much improved, we have seen a massive difference" "Staff follow things up well". People`s relatives and the staff spoke highly of the current manager. Their comments included: "She has helped us a lot" "Given us responsibility to increase our roles" "I like her a lot, a great manager, gets the best out of people" "Has really improved how we work as a team" "She supports us well" "She is honest, open and approachable" "Everything has improved since she came here" "Has done everything she said she would which is very reassurring". What has improved since the last inspection? The manager told us in the AQAA, `Personal DVD`s have been developed of service users to enable the people supporting them to have a better understanding of their needs.` We looked at one of these and found they gave a good picture of the person and how they liked their care and support to be carried out. The manager said they were hoping that everyone who uses the service would have their own DVD in the near future, that staff could use alongside the written care plans. Staff said they felt they had more time to spend with people and finding out more about what they like to do or understanding how they communicate. One person`s lifestyle has improved greatly by staff understanding more about what causes them distress and irritation. Records showed that people were now taking part in more activity within the home. Staff said the new multi-sensory room had been a huge success with people in the home. On the day of our visit we saw people really enjoying the benefits of this room and its facilities. Relatives also said how much more welcoming the home has been recently and there is a "Great atmosphere". We also noticed that the home`s atmosphere was calmer and more relaxing for everyone. The home is a lot more welcoming and comfortable for people. There have been a number of improvements made to the home`s environment. These include: The lounges and dining rooms have been re-decorated and re-furnished. New pictures and shelving have been put up and soft furnishings and ornaments where people will tolerate them. The style is modern and minimalist to suit the needs of the people who live at the home. The lounges have both got large plasma screen televisions. The bathrooms and corridors have also been re-decorated. Some of the bathrooms still look a bit stark and institutionalised and would benefit from some ornamentation to make them more appealing. A new bath has been fitted that is a specialist bath to meet the needs of people who need support with bathing. This bath also has a jacuzzi feature which staff said people really enjoy. A number of bedrooms have had new floor covering and have been re-decorated. There is the new multi-sensory room that has been fitted out with high quality multisensory equipment. What the care home could do better: The health and safety risks associated with the lack of suitable equipment for staff to use when moving and handling must be assessed and supported by a management plan. This will ensure everyone`s safety and minimise risks to people. Specialist equipment needed to ensure the safety of people who use the service and staff must be obtained by the home. This will make sure people are safe and prevented from undue harm. People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. Some consideration should be given to providing staff with training in the methods of person centred planning. This would help them to develop plans that are very individual, person centred and focus on what people want out of life. There should be systems in place to make sure medication administration records (MAR) sheets are checked frequently so that any errors can be picked up promptly. Medication returned to the pharmacy should be signed for by the person collecting it, therefore reducing the risk of any mishandling of medication. Staffing levels should remain under review to make sure there are enough staff to meet the needs of the people who use the service. All records relating to health and safety checks carried out on the home should be available at the home for inspection so that safety matters can be checked. Key inspection report Care homes for adults (18-65 years) Name: Address: Sheldon Ridge Nursing Home 1/3 Bierley Lane Bradford West Yorkshire BD4 6AB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Sheldon Ridge Nursing Home 1/3 Bierley Lane Bradford West Yorkshire BD4 6AB 01274688029 01274684320 sueroberts@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Brunel & Family Housing Association Limited care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Sheldon Ridge is registered to provide long term nursing care for thirteen adults with challenging behaviour, physical needs, and learning disabilities. The home is situated in the village of Bierley and is close to local amenities and a main bus route into Bradford City centre. The home was originally two purpose built bungalows; an extension now links the bungalows. There are communal lounges and dining areas and all bedrooms are single occupancy. The home has an enclosed rear garden, with level access from the lounges. The provider of the home is Yorkshire Housing Trust, many of the staff are employed by Bradford District Care Trust. Information on fees at the home can be obtained by contacting the manager. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 13 2 6 0 5 2 0 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit by one inspector who was at the home from 12:45 until 21:50 on 15th December 2009. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements made in January and May 2009. Before the inspection we reviewed accumulated evidence about the home. This included looking at any reported incidents, accidents and complaints. We used this information to plan the inspection visit. Following the key inspection in January 2009, we carried out a further random inspection in May 2009 where we saw some progress had been made in addressing the Care Homes for Adults (18-65 years) Page 5 of 36 shortfalls we identified in January 2009. We asked the home to provide some information before the visit by completing an Annual Quality Assurance Assessment (AQAA). This was completed well and gave us all the information we had asked for. We looked at a number of documents during the visit and visited all areas of the home used by the people who live there. We spent a good proportion of time talking with the manager, visitors and staff. We also spent some time interacting with people who live at the home and observing staffs practice. Comments made to us during the day appear in the body of the report. We sent out survey forms before the inspection providing the opportunity for people to comment on the service, if they wish. None of these have been returned at the time of writing the report. Care Homes for Adults (18-65 years) Page 6 of 36 What the care home does well: What has improved since the last inspection? The manager told us in the AQAA, Personal DVDs have been developed of service users to enable the people supporting them to have a better understanding of their needs. We looked at one of these and found they gave a good picture of the person and how they liked their care and support to be carried out. The manager said they were hoping that everyone who uses the service would have their own DVD in the near future, that staff could use alongside the written care plans. Care Homes for Adults (18-65 years) Page 7 of 36 Staff said they felt they had more time to spend with people and finding out more about what they like to do or understanding how they communicate. One persons lifestyle has improved greatly by staff understanding more about what causes them distress and irritation. Records showed that people were now taking part in more activity within the home. Staff said the new multi-sensory room had been a huge success with people in the home. On the day of our visit we saw people really enjoying the benefits of this room and its facilities. Relatives also said how much more welcoming the home has been recently and there is a Great atmosphere. We also noticed that the homes atmosphere was calmer and more relaxing for everyone. The home is a lot more welcoming and comfortable for people. There have been a number of improvements made to the homes environment. These include: The lounges and dining rooms have been re-decorated and re-furnished. New pictures and shelving have been put up and soft furnishings and ornaments where people will tolerate them. The style is modern and minimalist to suit the needs of the people who live at the home. The lounges have both got large plasma screen televisions. The bathrooms and corridors have also been re-decorated. Some of the bathrooms still look a bit stark and institutionalised and would benefit from some ornamentation to make them more appealing. A new bath has been fitted that is a specialist bath to meet the needs of people who need support with bathing. This bath also has a jacuzzi feature which staff said people really enjoy. A number of bedrooms have had new floor covering and have been re-decorated. There is the new multi-sensory room that has been fitted out with high quality multisensory equipment. What they could do better: The health and safety risks associated with the lack of suitable equipment for staff to use when moving and handling must be assessed and supported by a management plan. This will ensure everyones safety and minimise risks to people. Specialist equipment needed to ensure the safety of people who use the service and staff must be obtained by the home. This will make sure people are safe and prevented from undue harm. People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. Some consideration should be given to providing staff with training in the methods of person centred planning. This would help them to develop plans that are very individual, person centred and focus on what people want out of life. Care Homes for Adults (18-65 years) Page 8 of 36 There should be systems in place to make sure medication administration records (MAR) sheets are checked frequently so that any errors can be picked up promptly. Medication returned to the pharmacy should be signed for by the person collecting it, therefore reducing the risk of any mishandling of medication. Staffing levels should remain under review to make sure there are enough staff to meet the needs of the people who use the service. All records relating to health and safety checks carried out on the home should be available at the home for inspection so that safety matters can be checked. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 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 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs will be assessed before admission to the home to make sure Sheldon Ridge is the right place for them. Evidence: There have been no new admissions since our last inspection of the home. The home has an admissions procedure in place and in the AQQA the manager described how any new admissions to the service would be managed, taking into consideration the needs of the person referred to the home and the needs of people who currently live there. The manager also said in the AQAA, All service-users have been referred to the community learning disability team to be re- assessed ensuring we are providing the right level of support for each service user. and Continuing health care have reassessed three service-users. Funding has been approved for two service users. This enables them to have regular 1-1 support and has improved the quality of their lives. Peoples needs are also re-asessed by staff looking at care plans on a monthly basis Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: and updating them with any changes. People who live at the home seemed comfortable and relaxed in their surroundings. Peoples relatives said they were pleased with the choice of this home. Their comments included: Things are great here Couldnt have chosen anywhere better Always very welcome, feel like part of the family Atmosphere is much improved these days. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people are encouraged to make decisions about their lives and are involved in planning their care and support as much as they can be. This could be extended if greater emphasis was placed on person centred planning methods. Evidence: In the AQAA, the manager said, Each service-user has their own personal service plan (PSP).This is agreed with the individual, carers, family members,advocates and any other relevant agencies or specialists. We were also told in an action plan that the manager provided following our last inspection that care plans and risk assessments were all to be updated. We looked at care plan and risk assessment records for some people who live at the home. We found some of them to be person centred and individual to each person. Some plans had clear and detailed instruction on how the needs of people who use the service are to be met. They had some good information about how people should be supported with personal care and communication needs. The manager also told us in Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: the AQAA, Personal DVDs have been developed of service users to enable the people supporting them to have a better understanding of their needs. We looked at one of these and found they gave a good picture of the person and how they liked their care and support to be carried out. The manager said they were hoping that everyone who uses the service would have their own DVD in the near future, that staff could use alongside the written care plans. We could see that some work had been done to update and improve the care plans and risk assessments. However, there were still some shortfalls with them. Terms such as full assistance, check regularly and goes to bed at a reasonable time do not accurately describe peoples care needs. However, staff were,in the main, familiar with what was written in peoples care plans and could talk confidently about the support they give. They had good knowledge of peoples individual support needs and could describe peoples routines well. Staff said they found the care plans easier to follow now and confirmed that they were regularly kept up to date on any changes made to them. Peoples relatives said they were involved in the drawing up of the care plans. Comments included: We feel listened to They ask us about the care plans and invite us to meetings We feel fully involved in (name of persons) care. Due to the complex communication needs of the people who use the service, it is difficult to involve them in planning their own care. As previously mentioned, the DVDs have gone some way to promote this and make sure people are included. Care plans and risk management plans would however, still benefit from having more detail that clearly outlines their support needs to make sure their needs are fully met. Staff would benefit from some training in the methods of person centred planning for people who have a learning disability. This would help them to develop plans that are very individual, person centred and focus on what people want out of life. One person who uses the service has moving and handling needs that create risks for the staff as the home does not have the right equipment in place for this person. There was no risk assessment or management plan for the risks to staff and how these can be managed or minimised. This must be addressed. Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: The care plans are reviewed monthly and a summary is completed to show how peoples health and welfare has been, what has been happening in their lives and if they are enjoying their activities and lifestyle. People are encouraged to make choices and decisions about what they do. Staff said they try to encourage people to make choices every day. They said people choose when to get up, what to wear, where to go out, what to eat, what activities to take part in and when to go to bed. On the day of our visit, most people had retired in to their nightwear by 8pm. Staff said this was a definite choice people made and that they seemed to enjoy the relaxation of being comfortable in their nightwear. We saw staff being respectful of peoples right to choose not to do something or to say no to what was offerred, for example an activity. The manager said they are currently trying to develop a picture menu which may help some people to choose foods more easily. Staff said they felt they had more time to spend with people and finding out more about what they like to do or understanding how they communicate. One persons lifestyle has improved greatly by staff understanding more about what causes them distress and irritation. The manager said she was hoping to introduce relatives meetings and forums to the home so that they may be able to comment more on behalf of the people who live at the home. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make some choices about their lifestyle. In the main, social, educational, cultural and recreational activities meet peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: At our last two visits to the home we said there was a lack of activity for people and that they were bored a lot of the time. We said that this must be addressed and things must improve for people to make sure they have a fulfilling lifestyle. The manager provided us with an action plan following our last visit and said activity plans were being introduced, activity organisers were to be deployed to each bungalow and an additional mini-bus had been obtained. In the AQAA, the manager said, Service-users are given opportunity to take part in activities they enjoy, and offered opportunities to take part in new activites with Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: support from activities assistants and support staff. Each Service-users Personal Service Plan contains details of their preferences, abilities and support needs in social settings The home has a specific social and leisure plan which offers a range of choices identifying the support when going out and on what day. However, the manager then went on to say, The home is currently without two full time activity assistants. Activities within the home have been taking place, but community access has been difficult, as the staff within the home are unable to drive the 8 seater bus. And Leisure opportunities can be limited at the weekend and evenings due to the lack of drivers within the staff team. Staff said they thought that people did not get out of the home often enough to participate in activities they enjoy because of the staff shortage situation. For example, a person who really enjoys swimming has not been for over three months. Records showed that some people only have opportunity to leave the house about once per week. Other people had more opportunities, on average about three times per week. And those people who had received additional funding to meet their needs were getting out most days. One staff member said, People get out at least once per week. It was disappointing that this seemed to be acceptable, especially when other staff said people needed to get out more. Staff said they try to make up for the lack of community based activity by doing more in the home. They said they had been encouraged to get involved in activities such as foot spas, nail painting, arts and crafts, cooking and taster sessions, the multi-sensory room and jacuzzi relaxation baths. Staff said the new multi-sensory room had been a huge success with people in the home. On the day of our visit we saw people really enjoying rhe benefits of this room and its facilities. We asked the manager what she had done to try and reduce the impact of staff vacancies on peoples lifestyles. She said she had redeployed one of the care staff as an activities organiser and was covering their care hours with regular staff from an agency. She said they were tryng to recruit staff who could drive and were also considering swapping the larger mini-bus for something smaller that more staff could drive. She also said that she was urging the organisation to make a decision on the future funding of the activity organisers posts as this has not currently been agreed on. On the day of our visit, a number of activities took place that people seemed to enjoy. These included: Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: A walk in the local area. A visit to the local shops. Using the multi-sensory room. A family visit. A jacuzzi bath. Staff were also generally interacting with people, chatting, watching television, listening to music and walking around the home. Records showed that people were now taking part in more activity within the home. A relative spoke highly of this years Christmas party, saying it was the best they had ever had at the home. Relatives also said how much more welcoming the home has been recently and there is a Great atmosphere. We also noticed that the homes atmosphere was calmer and more relaxing for everyone. People must, however, be given more opportunities to leave the home and participate in activities within the community. This will enhance their lifestyle and well-being. Three people who live at the home had a short holiday break in Blackpool this year. The manager is now looking into ways of giving more people the opportunity for a holiday in the future. In the AQAA, the manager said, Service-users are offered a healthy balanced diet. Dietician and speech and language are involved with individuals within the service. Ensuring individuals receive a balanced, nutritional varied diet to meet their health needs. All service-users have had a nutritional assessment carried out on their behalf. These are regulary reviewed including any risk factors to the individual i.e low weight, obesity, eating disorders. Qualified chefs prepare all meals. Service-users are offered a choice of suitable menus, which meet their dietary and cultural needs. Staff said mealtimes were now better organised, not as rushed and they had time to give people the support they needed. Staff also said the food in the home was good, varied and plenty of choice. They said people can choose an alternative to what is on the menu if they fancy something different. The chef had good knowledge on supporting people with any special diets or making sure people who were nutritionally at risk have their foods enhanced to make them more nutritious. The chef works with the nursing staff and dieticians to make sure people get the foods they need. Relatives spoke highly of the food in the home. They said it always looks nice and staff make sure plenty of drinks and snacks are available. Care Homes for Adults (18-65 years) Page 18 of 36 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. Peoples general healthcare needs are, in the main, well met and based upon their individual needs. Evidence: In the AQAA, the manager said, Each Service-user has a named nurse and associate nurse who is responsible for the coordination of that individuals care. The named nurse is responsible for ensuring that each Service-user has regular health checks with the dentist, podiatry, opticians, audiologist,G.P, consultants and make appropriate referals when required. Despite the gaps in care planning as mentioned in the individual needs and choices section of this report, staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live at the home looked well cared for, well dressed and groomed. Good records are kept of health appointments and their outcomes. Staff make sure that people are given support to attend appointments to meet their health needs. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: People are referred to health professionals when needed. For example, dieticians, physiotherapists and specialist nurses. Staff said that the nursing staff made sure they were skilled and competent to deal with peoples medical needs such as epilepsy. Nursing staff have made sure there are protocols in place which give staff clear guidelines on managing emergency situations with epilepsy management. Nursing staff said they felt up to date with their training to meet health needs. One told us they had recently completed training in palliative care and meeting peoples nutritional needs. Some people who live at the home have specialist needs regarding their visual impairment. We saw staff supporting people well, guiding them carefully and explaining any task they were involved with. Staff have not had any specific training on meeting the needs of people who are visually impaired but have adapted their practice to take peoples needs into consideration. Care staff said they always sought the advice of the nurse on duty regarding peoples health care needs. During our visit, we saw this to be the case when a situation arose where first aid was needed. Staff also said they felt they had more time now to attend to peoples personal care needs in a more relaxed manner, for example, staff said some people enjoy a lie-in followed by a long soak in the bath. A relative told us that the service was always prompt in getting medical attention for people and were good at keeping relatives informed. One said that staff were very good when accompanying people to hospital appointments. They said they always try to make it as least distressing as possible for the person. Relatives also told us they were very happy with the standards of care at the home. Their comments included: More than happy with (name of persons) care She can dress herself and do more for herself since being here They always provide staff who are familiar with (name of person) and know her care plans. In the AQAA, the manager said, Medicines are stored and administered in accordance within regulations. All Service-users have at least an Annual medication review with their G.P. and consultant from the learning disability out patient team. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: We looked at medication and medication records. The home uses a monitored dosage pre-packed system for medicines. There are good ordering and checking systems in place. We checked some medication administration records (MAR) sheets. We found there were a number of errors with medication administration. There were medications that had not been signed for, so it was unclear if they had been given. These were pointed out to the manager who said they would be investigated. There should be systems in place to make sure MAR sheets are checked frequently so that any errors can be picked up promptly. There is a system in place for the return of unused medication. Medication to be returned and destroyed is recorded in the home and then placed in a sealed container that is collected. However, the person collecting the medication does not sign to say what they have collected. This could lead to the mishandling of medication. Care Homes for Adults (18-65 years) Page 21 of 36 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. People who use the service are able to express their concerns and are protected from abuse. Evidence: In the AQAA, the manager said, Easier Read Complaints procedure is available and accessible to Service-users and visitors, this is displayed in the entrance to the building. All the people we spoke to were aware of how to complain and told us they had used the complaints procedure in the past and had felt they were taken seriously. The home has not received any complaints since our last visit. We have not received any concerns either. Staff are aware of their responsibilty to report any concerns or complaints that are made to them. They are also aware of how people who live at the home express their dissatisfaction or show they are unhappy with anything. This often relies on being observant of peoples none verbal communication such as body language. The manager said that most staff had received training in safeguarding adults or that she makes sure they cover this in staff meetings while waiting for the training courses to be provided. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. There has been one safeguarding adults incidents in the service since the last inspection. This has been properly reported and acted upon promptly. The manager is fully aware of the procedure in referring incidents on to the local authority for them to be investigated. We looked at incident reports in the home. New ones have been introduced where staff record the details of the incident and any action that is subsequently taken. The manager looks at all the incident reports, signs them to say she has seen them and monitors them for any patterns or trends. Staff and the manager all said that no-one in the home is subject to any form of restraint. They said they use de-escalation techniques to manage behaviours that challenge the service and others. Some training is given on this, it is called Breakaway training and should be updated every year. The manager is aware that a number of staff need their annual update. She said the organisation had not been able to provide enough training to meet all staffs needs and that she was working on obtaining more. We saw good practice from staff in that they showed good skills in re-directing people from negative behaviours and helped people to become calm if they were agitated. Records are kept of the finances of people who live at the home and their monies are kept safe. Care Homes for Adults (18-65 years) Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the environment is now more homely, comfortable and in the main, safe for people who live at the home. Evidence: In the AQAA, the manager said, The home is decorated to incorporate a bright and cheerful atmostphere. Service-user rooms are decorated to individual taste and people are involved in choosing and purchasing furniture, fittings. The home is a lot more welcoming and comfortable for people. There have been a number of improvements made to the homes environment. These include: The lounges and dining rooms have been re-decorated and re-furnished. New pictures and shelving have been put up and soft furnishings and ornaments where people will tolerate them. The style is modern and minimalist to suit the needs of the people who live at the home. The lounges have both got large plasma screen televisions. The bathrooms and corridors have also been re-decorated. Some of the bathrooms still look a bit stark and institutionalised and would benefit from some ornamentation to make them more appealing. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: A new bath has been fitted that is a specialist bath to meet the needs of people who need support with bathing. This bath also has a jacuzzi feature which staff said people really enjoy. A number of bedrooms have had new floor covering and have been re-decorated. There is the new multi-sensory room that has been fitted out with high quality multisensory equipment. It was disappointing to see that the doors in the homes corridors and those to the dining rooms have not been re-varnished or painted in line with the style of the new decor. These doors give the home an institutional feel and are the type of doors that are more suited to a clinical environment. The manager was also disappointed with these doors and felt they were letting the new decor down. A tour of the home was carried out. Communal areas, bathrooms and bedrooms were visited. The home was warm and looked clean and homely, especially peoples bedrooms which were highly personalised and showed peoples individual tastes and personality. The home was also decorated for Christmas, with decorations and a Christmas tree. The manager has still got more plans to further the improvements to the home. She said she wanted to get new floor covering for communal areas and that there were still some bedrooms to be re-decorated. She said she would also like to get some landscaping to the garden area and develop a sensory garden. For over a year now, the home has been trying to obtain a specialist piece of equipment for someone who lives at the home. An occupational therapist has recommended what is needed. However, the manager said there had been difficulties in obtaining this due to lack of agreement on who or how it should be funded. In the meantime, the person using the service and staff are put at risk by the lack of this piece of equipment. This situation must be resolved. Staff carry out regular checks around the home to make sure everything is safe and there are no hazzards for people. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. The environmental health officer visited the home in May 2009 and awarded the home Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: 4 out of 5 stars. Care Homes for Adults (18-65 years) Page 26 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, staff are trained and competent to meet the needs of the people who use the service but there may not always be enough staff to meet peoples needs fully. People are protected by the homes recruitment procedures. Evidence: Relatives of people who use the service spoke highly of the staff. They said, Staff are wonderful with (name of person) Staff attend to all (name of persons) needs, even get clothes specially made for them Big improvement with staff since Lisa (current manager) came in, they are more confident Staffs skills are much improved, we have seen a massive difference Staff follow things up well. People who live at the home seemed comfortable and relaxed with staff, it was clear Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: they got on well. Last time we visited the home we said they needed more staff to meet the needs properly of the people who live there. The manager told us that staffing levels have increased. She said that two people now have extra funding for one to one hours every day and in addition to this she has increased the number of staff to seven from six on the morning shift. They also provide one to one staff support from these numbers to another person who uses the service. She said they are not funded specially for this but provide it as it is needed. The numbers of people who live at the home has now been reduced to 12 from 13 too. The manager has also deployed staff into two teams, one for each bungalow, to provide more continuity and consistency of staff support to people. Staff said this was working well. Despite all of the above, the home remains short staffed due to vacancies, staff redeployment to other homes and maternity leave. They are also providing less activity organiser hours. The manager would like nursing staff to lead the shift but not be part of the numbers needed to provide the direct care and support. This has not been possible recently. Staff said they felt staffing was now better and that they had more time for people who live at the home. But as previously mentioned they said being short of staff and providing so much one to one staffing did affect their ability to get people out of the house. They also said that health appointments had to take priority for use of the homes transport and staff who can drive. Peoples relatives said they thought there was enough staff and the manager was doing her best to provide what is needed. We looked at rotas and these showed that staffing levels had increased slightly as mentioned above. The manager is trying to reduce the impact of staffing vacancies and gaps by the use of regular agency staff who know the needs of the people who live at the home. We spoke to some of these staff and they confirmed they worked regularly at the home. They also said how much they enjoyed working there and that they were given good support. The manager also said she has asked senior management to review the staffing levels and management structure of the home. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: We looked at recruitment records These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. However, the records, such as application forms and references for people who have been employed a number of years ago are not held at the home and could not be checked. The manager said she was in the process of trying to obtain these from the head office to get all staffs files up to date. In the AQAA, the manager said: We have reviewed the training file and introduced a training matrix to ensure we can track and arrange training when required There has been difficultly in updating training due to lack of availability of places which has lead to staff been unable to keep up to date and improve their skills Staff to attend all mandatory training identified in the training analysis, and attend additional areas identified. We loooked at staffs training records and it became apparent on the day of the visit, that the training records were not up to date. The reviews that had taken place as above were based on incorrect records. Staff told us and showed us their certificates to show that they had completed training, which records said they hadnt. The manager agreed that a new review of the training needs of staff was required and then a training plan to meet this would be put in place. Staff we spoke to during the visit said their training was, in the main, up to date. They said they had completed an induction when they first started and then had regular updates in topics such as moving and handling, safeguarding adults, food hygiene, first aid and breakaway techniques. Also the manager told us that nineteen out of twenty seven staff have completed an NVQ (National Vocational Qualification) in care at level 2 or above. This means they are qualified to carry out their job. Training has also recently been given on Valuing People. This is training on understanding the specific needs of people who have a learning disability. Staff said they now have regular one to one meetings with the nurse in charge to see how they are getting on in their role and if they need any training or support. This is called supervision. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is overall well managed, the interests of the people who use the service are seen as important to the manager and staff and are, in the main, properly safeguarded. Evidence: In the AQAA, the manager said, Over the last 12 months there have been 3 managers at Sheldon Ridge, which has made consistent and sustained improvements difficult. However the current manager has only been in post for over 7 months, She has over 12 years management experience and over 20 year experience working with adults who have a learning disability. The current manager is not based at Sheldon Ridge full time as she also manages supported living services. This has worked well over the last few months. She has requested that Bradford District Care Trust employ a deputy manager to help maintain stability and consistency within the home. The manager, who is not registered with us for this service, told us that she spends on average 30 hours per week at the home. These hours are not marked on the homes rota to show when the manager is there. However, staff confirmed that she is at the Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: home the majority of the time. The manager has the registered managers award and an NVQ 4 in social care management. She told us that the organisation are currently re-advertising for a manager with a nursing qualification, as previous recruitment attempts have been unsuccessful. Once this person is in post they will apply to register with the CQC. This will make sure there is someone accountable for the running of the home. Peoples relatives and the staff spoke highly of the current manager. Their comments included: She has helped us a lot Given us responsibility to increase our roles I like her a lot, a great manager, gets the best out of people Has really improved how we work as a team She supports us well She is honest, open and approachable Everything has improved since she came here Has done everything she said she would which is very reassurring. The manager and nursing staff have completed some training in the Mental Capacity Act, which has given them a better understanding of the rights and decision making processes of people who live at the home. The manager said further training is to be organised on the Deprivation of Liberty Safeguards which will give them more knowledge on protecting peoples rights and liberty. Records we looked at showed that regular health and safety checks are carried out. In the AQAA, the manager said: The home has policies and procedures which enable the home to meet the required standards Risk assessments have been carried out to ensure all safe working practices Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: Maintenance contracts are in place to ensure checks are carried out electrical equipment, water temperature, legionella checks. She also said relevant health and safety policies and procedures were in place, and reviewed. And that equipment has been serviced or tested as recommended by the manufacturer or regulatory body. However, on the day of the visit, the certificates for gas and electrical safety could not be located. The manager said she would forward them to the CQC when she had obtained them from the housing provider. Accident records are completed, followed up and monitored for any patterns trends or ways of avoiding future accidents. As mentioned in the Environment section of this report, equipment that ensures everyones health and safety must be provided promptly. A senior manager from the organisation visits the home monthly and conducts monthly provider reports with requirements for improvement. There was a period of time earlier in the year when no senior manager had visited for a number of months. This situation now seems to be resolved. The organisation seeks the views of people who use the service or their by sending out a questionnaire so that they can get feedback on how people think the service can improve. The manager had not yet received any back this year. Care Homes for Adults (18-65 years) Page 32 of 36 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 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 16 People must be given more opportunities to leave the home and participate in activities within the community. This will enhance their lifestyle and well-being. 31/01/2010 2 29 23 Specialist equipment needed 31/03/2010 to ensure the safety of people who use the service and staff must be obtained by the home. This will make sure people are safe and prevented from undue harm. 3 32 18 A review of staffs training 31/03/2010 needs must take place, and training must be provided where gaps are identified. This will make sure staff are competent to meet the needs of the people who use the service. Care Homes for Adults (18-65 years) Page 34 of 36 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 6 People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. Some consideration should be given to providing staff with training in the methods of person centred planning. This would help them to develop plans that are very individual, person centred and focus on what people want out of life. People who live at the home should be given the opportunity of an annual holiday that meets their needs. There should be systems in place to make sure medication administration records (MAR) sheets are checked frequently so that any errors can be picked up promptly. Medication to be returned and destroyed should be signed for by the person collecting it, therefore reducing the risk of any mishandling of medication. Staffing levels should remain under review to make sure there are enough staff to meet the needs of the people who use the service. A training plan should be put in place so it is clear who has done what training and when updates are due. All records relating to health and safety checks carried out on the home should be available at the home for inspection so that safety matters can be checked. 2 6 3 4 14 20 5 20 6 33 7 8 35 42 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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