Care Home: Sherbutt House

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What the care home does well People are assessed before they move into the home. This helps to make sure that the home are aware of their needs and that the staff have the skills and knowledge to be able to meet these needs.Sherbutt HouseDS0000019724.V378199.R02.S.docVersion 5.3People have plans of care and person centred plans that clearly identify their needs and how these are to be met. Staff are aware of these and use these in practice to support people with their lives. People are able to choose and participate in a variety of activities, with staff support as necessary, enabling them to live as full a life as they choose. Staff support people to help them to maintain good relationships with their relatives, promoting positive relationships in a person’s life. People’s dietary needs are met, with both a balanced diet that they can also choose and a diet that, when necessary, will help them to manage any health needs they may have. Individual choices over how people receive personal support is well documented to ensure that personal preferences are met and people have increased choice and control in their lives. People are able to raise concerns and have these addressed within the home, enabling them to be more involved in the decisions in the home and in expressing choices. People live in a clean, warm and comfortable home, where they can personalise their rooms and make them their own. Staff are only employed after a thorough recruitment process which helps to make sure that they are suitable to work with vulnerable people and have the necessary skills to help people to meet their needs. The manager is experienced in care services and has continued to undertake training to update her skills. This helps to make sure that the home is run as well as possible and that the service people receive is of a consistent standard. Health and Safety checks are undertaken in the home to make sure that people live in a home that is safe. What has improved since the last inspection? Risk assessments have been further developed in the home and are now very detailed. They assist in minimising risks and assist the person to live their lives as they wish, whilst as far as possible maintaining safety. Staff breaks have altered so that the need to use an intercom to ensure people’s safety has ceased. This means that people’s privacy is now fully respected.Sherbutt HouseDS0000019724.V378199.R02.S.docVersion 5.3Support for people to self administer medication has improved through more detailed assessments and recording. This enables people to have more control in their lives. Any incidents within the home are referred as necessary to the Safeguarding Adults team. This helps to make sure that peoples’ needs are fully met and that people are fully protected from the risk of harm. Several areas of maintenance have been undertaken, helping to ensure that people have a comfortable home to live in. What the care home could do better: Storage tins for medication that is to be self administered could be fastened inside a drawer or cupboard to reduce the possibility of this being taken away by someone else. Hand written entries onto Medication Administration Records (MAR) charts should be countersigned to reduce the risk of errors. Risk assessments and actions could be undertaken to reduce the risk of heavy fire doors banging onto people and potentially causing injury. Petty cash systems should be improved to make sure that funds are always available so that people do not on any occasion pay for staff lunches. Notifications to the commission could also include the calling of the emergency services for people’s ongoing medical conditions. This would help to ensure a full as picture as possible is held about life for people in the home. Key inspection report CARE HOME ADULTS 18-65 Sherbutt House 106 Yapham Road Pocklington East Yorkshire YO42 2DX Lead Inspector Sarah Rodmell Key Unannounced Inspection 27th October 2009 09:15 Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Sherbutt House Address 106 Yapham Road Pocklington East Yorkshire YO42 2DX 01759 304149 01759 828336 gillianlilley@sherbuttservices.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Linda Woodhead Mrs Gillian Lilley Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one service user with a physical disability. Date of last inspection 1st August 2008 Brief Description of the Service: The home is registered to provide personal care for 15 people with a learning disability. People live in two houses which are on the same site, Sherbutt House and Coach House. Eight people live in Sherbutt House and seven people live in Coach House. Apart from one shared room all accommodation is in single rooms. The rooms in Coach House have en-suite facilities and there is one en-suite room in Sherbutt House. The accommodation in Sherbutt House it situated over three floors and there is a recently installed passenger lift in the Coach House. The premises are located on the outskirts of Pocklington, which is a small town in the East Riding of Yorkshire; local facilities include shops, cafes and a swimming pool. There are large lawned gardens, which are safe for people to enjoy. The home is well furnished, domestic in style and in keeping with the local community. The home owns three vehicles, which are used by people who live at the home. A copy of the latest Commission for Social Care Inspection (CSCI) report is available at the home. People who live at the home are supported in arranging and paying for goods or services like hairdressing with their own money. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection on 1 August 2008, including information gathered during a site visit to the home. The unannounced visit was undertaken over one day by one inspector. It began at 9.15 am and finished at 4.00 pm. On the day of the visit the inspector spoke with people who live in the home, the manager and staff. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The manager confirmed the information sent in the Annual Quality Assurance Assessment form (AQAA) to the CQC from the home. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people who use the service. The manager told us that the current fee for residential care is £372.00£924.89 per week. At the end of this visit, feedback was given to the manager and two of the staff on our findings, including any requirements and recommendations that may be in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People are assessed before they move into the home. This helps to make sure that the home are aware of their needs and that the staff have the skills and knowledge to be able to meet these needs. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 6 People have plans of care and person centred plans that clearly identify their needs and how these are to be met. Staff are aware of these and use these in practice to support people with their lives. People are able to choose and participate in a variety of activities, with staff support as necessary, enabling them to live as full a life as they choose. Staff support people to help them to maintain good relationships with their relatives, promoting positive relationships in a person’s life. People’s dietary needs are met, with both a balanced diet that they can also choose and a diet that, when necessary, will help them to manage any health needs they may have. Individual choices over how people receive personal support is well documented to ensure that personal preferences are met and people have increased choice and control in their lives. People are able to raise concerns and have these addressed within the home, enabling them to be more involved in the decisions in the home and in expressing choices. People live in a clean, warm and comfortable home, where they can personalise their rooms and make them their own. Staff are only employed after a thorough recruitment process which helps to make sure that they are suitable to work with vulnerable people and have the necessary skills to help people to meet their needs. The manager is experienced in care services and has continued to undertake training to update her skills. This helps to make sure that the home is run as well as possible and that the service people receive is of a consistent standard. Health and Safety checks are undertaken in the home to make sure that people live in a home that is safe. What has improved since the last inspection? Risk assessments have been further developed in the home and are now very detailed. They assist in minimising risks and assist the person to live their lives as they wish, whilst as far as possible maintaining safety. Staff breaks have altered so that the need to use an intercom to ensure people’s safety has ceased. This means that people’s privacy is now fully respected. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 7 Support for people to self administer medication has improved through more detailed assessments and recording. This enables people to have more control in their lives. Any incidents within the home are referred as necessary to the Safeguarding Adults team. This helps to make sure that peoples’ needs are fully met and that people are fully protected from the risk of harm. Several areas of maintenance have been undertaken, helping to ensure that people have a comfortable home to live in. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are assessed before they move into the home to make sure that the staff are aware of these and are confident that they can be met in the home. EVIDENCE: The manger recorded in the AQAA, ‘All clients are assessed prior to entering the home via a community care assessment and Sherbutt House pre-service information is collated through out our own unique assessment procedure. All initial assessments and visits which include a visit to the client within their current environment and a visit to the desired service, are completed by myself (the manager), the service manager or the duty manager, advocates for the clients are accessed through mencap advocacy service as to the need of the individual client and the clients family/friends are consulted with the consent of the client. To ensure equal opportunities and anti discriminatory practise, the referral policy includes an eligibility criteria, which assists in the assessment of the service to meet the needs of the individual and may prompt Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 10 an explanation by the manager of refusal to individuals whose needs can not be met. Following assessment individual care plans are compiled.’ She also confirmed this information to us on the day of the visit. We examined the care files of three of the people who live in the home. One of these people had moved into the home in the last year. All of the files included an assessment of need of the individual completed by the home including a pre-admission assessment. Where possible, a copy of the Community Care Assessment completed by the Local Authority had been obtained. These assessments help the home to make sure that they are fully aware of the persons’ needs before they move into the home and that these needs can be met. The information gained was used to develop an individual care plan, with some recently being reviewed and developed into Person Centred Plans. Throughout the care files people had signed to say that they agreed to the content about them. We did not speak directly to the person who had recently moved in, although we did observe them in their home. They were clearly relaxed and were chatting with the staff throughout our visit. Staff responses were appropriate and it was clear that they knew the person and their needs. The two people we spoke to told us that it was ‘alright’ living in the home. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their lives and make decisions with support through care planning and risk assessment processes. EVIDENCE: We looked at the care files for three of the people who live in the home. The care files contained a variety of information, this included: • • • • Risk assessments. A plan of care. Personal Hygiene needs. Domestic Skills. DS0000019724.V378199.R02.S.doc Version 5.3 Page 12 Sherbutt House • • • • Daytime activities. Health Needs. Social and Leisure needs. Aspirations and goals. People had when possible signed in their care plans to confirm that they agreed to the content. In addition many of these care plans have now been developed into Person Centred Plans. The person centred plan described in detail the persons’ day and wishes about their life and choices they make. This included pictures and a number of photos of the person, for example, a photo of them in their bedroom, showing that this was their room. When we asked one person they told us that they were happy with their care plan. Any specialist support is also recorded within the individual plan of care and letters from specialists are kept within the file. When we spoke to the staff they told us that they would refer to a person’s care plan or person centred plan if they needed to know about a person and how to support that person. The information recorded in the AQAA included, ‘Each care plan and person centred plan is individual to the individual client and within our unique system the clients plan of care gives procedure instruction to the care team with regards to all aspects of the clients life, including anti social behaviours, self harm etc.’ The risk assessments held in the care plans were detailed and varied according to the needs of the indivdual. Examples of these risk assessments included: • • • • Using the shower. The risk of fire. Medication. Road Safety. The information in the AQAA recorded that, ‘Any restrictions are advised following individual risk assessment and once agreed by the client/advocate, recorded.’ Care reviews take place within the home and the records included that each person and their keyworker will attend the review, with evaluations being signed by the person living in the home. These reviews included a review of any current risk assessments. We observed throughout our visit that people were supported to make decisions about their daily lives. For example , people were asked if they wanted to go out , if they wanted a drink and, if so, what type of drink did they want. We observed that people had chosen to go to day services, relax at Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 13 home, complete puzzles and to watch TV. People could also choose when to be in the lounge or their own room. Peoples daily notes included some of the decisions that people make including when they choose not to do something , for example, to not go out. A person centred plan also included ‘ how I make choices’. One person told us that they can make choices about things. Staff told us, ‘people live an ordinary life’, ‘they go into town if they want to’ and ‘if someone requests something specific we try to meet their needs’. They gave us good examples of assisting people to undertake chosen activities. Information in the AQAA included that ‘Clients are constantly encouraged to make decisions within their care and life through promotion within client meetings, client review, informed choice and key working/one to one sessions.’ Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live active lives, choosing how to spend their time and receiving a diet of their choice. EVIDENCE: On the day of the visit we observed that several people were attending adult education. Other people were either relaxing at home, undertaking domestic tasks, for example baking and tidying their rooms, or they were completing puzzles. Where necessary, we saw that staff gave good support with these activities, showing an understanding of the persons’ needs and respect for them. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 15 We asked people about the things that we do and they told us that they also relax in the garden, go to a café, day centre and college, go out for lunch, go to the cinema and go for walks. Staff told us that people choose what they want to do. We examined the care plans and daily diary notes for three of the people who live in the home. The care plans recorded that people undertook activities of their choice, which included both activities in their own home and in their local community. These activities included: • • • • • • • • Swimming. Shopping. Writing letters. Cleaning their room. Going out into town. Baking. Bowling. Drama Club. Information in the AQAA recorded that, ‘Several clients attend work link projects, night classes, outreach and gardening. Investigations are ongoing to support clients to find employment, education and training; currently clients are awaiting the 2009 prospectus from the local colleges and schools, and one client has had home tutoring with regards to literacy skills. A client has recently commenced work in a charity shop in which the care team support her on a one to one basis.’ When we asked staff they told us that people keep in contact with their families in a variety of ways. Some people telephone their relatives or write. People are able to visit at anytime and sometimes people go home for a weekend. We observed that one person questioned the staff about a relative and that the staff gave appropriate answers in a respectful way allaying any worries that this person may have had. One person’s daily notes included details that they had been supported to write a letter to their family. Information in the AQAA recorded that, ‘All clients are welcomed and encouraged to invite friends and family to their home. A visitor’s statement is displayed informing people about the provision of meals, drink and services. Clients may see visitors of their choice in their own private rooms, in the office, or in communal areas (with the consent of the other clients occupying the space). When arranging parties, clients are encouraged to invite family and friends. The service consistently hosts a Christmas and garden party each year Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 16 to which a good response from client’s associates is recorded. Clients have opportunities to make new friends and have done so through visiting local amenities such as the local public houses, libraries, leisure centres etc.’ We observed during the day that people were offered choices in their daily lives, choosing what to do and what to eat. People told us that they have choices and their daily notes recorded this; examples included choosing what to do and where to go. Peoples care files recorded that people may hold a key to their own room and we saw that staff respected this, knocking on peoples’ doors before entering. The manager told us that staff have breaks at different times to each other so that the service always has a member of staff present. Also, that the use of the monitor/intercom has ceased so that peoples’ privacy is fully respected. When staff were asked they gave us examples about how people choose what they wish to eat, and what activities to undertake. One example being that someone had decided to stop attending an adult education course. The information in the AQAA recorded that, ‘Clients are encouraged to exhibit personal choice and self manage time through investigating the communal areas of the home, spending time alone or in the company of others.’ People’s files included the details of their likes and dislikes, and this included food. Any recommendations made by specialists regarding diet were also recorded. One person had specific health needs regarding their diet and to assist this records were kept of their weight. People have a weekly menu that they help develop. We saw the menu sheet on display in the kitchen of the home; people’s requests for that week had been recorded on this. The manager told us that people receive fresh fruit and vegetables - the recording systems in the home could be amended to include this in more detail. Staff told us that people ask for foods and that this is typed onto the week’s menu - we also saw this on the menu. People told us that the food in the home was ‘alright’. Information in the AQAA recorded that, ‘Meals are offered through breakfast, lunch, evening, and supper. Clients are assisted to prepare packed lunches and obtain/prepare snacks as required - fresh fruit is openly available throughout the day. Hot and cold drinks are available on a continual basis or to the request of the clients. Meal times are unrushed, times are not set and are dictated by the client group/individual - clients have the option of eating meals in the garden, communal dining room, lounge or private space. Staff have meals with clients. The preparation of food respects individual choice and Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 17 culture/religious requirements. For example, when supporting the client whose beliefs included the Jehovah’s Witness faith, meals would never be prepared with blood enriched foods.’ Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal care, health and medication needs are met. EVIDENCE: People’s care plans detailed any support that an individual may require. This included personal support, for example, with personal hygiene. One person’s records clearly stated that they do not like taking a bath and would only wish to have a shower or ‘good wash’. Another person had health needs and required specific support with personal care. Again this was clearly documented in their personal file. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 19 We observed that staff spoke respectfully when people required personal support and noted that people’s appearances reflected their individual personalities, for example, with the style they chose to dress in. The manager told us that people have started to be involved in the recruitment of staff and information in the AQAA recorded that, ‘clients are asked whom they would like to assist them and participate in recruitment interviews to ensure a suitable staff team is available’. It also recorded that, ‘Clients are referred to Occupational Therapy, physiotherapy, etc, to ensure appropriate aide and specialised guidance is available.’ Individual health needs are also recorded in people’s plans of care. These records included any medical reports, records of visits to health professionals and the outcome of these visits. In addition there were records of visits from or to the dentist, optician and chiropody services. Where necessary, specific details of how to assist someone with a medical need were also recorded. When we spoke to people they told us that the staff support them and take them for medical appointments. They also said that staff help them to manage any medical needs within the home. The manager told us and we noted in one person’s records that they had been supported with a specific health need and after a short stay in hospital were able to return to the home. One of the staff team told us how medicines are managed in the home. All medicines are checked upon receipt to ensure that they are correct, and records are kept of this. Records are also kept of when medicines are administered or disposed of. We were told that there were no medicines that are ‘controlled’ held within the home. Peoples care plans include risk assessments to identify if the person is able to self administer any of their medicines. Where people are able to do so this is clearly recorded and checks are made, with records kept that they have successfully completed this. When people are not able to manage their own medicines they sign to confirm that they give permission for the staff to administer their medication on their behalf. Records are kept of sample signatures for the staff who administer medicines to assist with any audits. Occasionally staff have had to write people’s medicines onto a Medication Administration Record (MAR) sheet. This has usually been completed by one staff member and it is recommended that this is counterchecked and signed by a second staff member, to help in reducing the risk of errors occurring. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 20 Medication is stored in a locked cupboard in a separate area of the home. When people self medicate they keep their medicines in a locked tin in their rooms. It is recommended that this tin is kept out of sight preferably by permanent attachment to the inside of a drawer or cupboard so that the tin cannot easily be taken out of the room by someone else. The manager told us that all staff have completed accredited medication training and that some staff are now undertaking a second medication course. Staff told us that as part of their supervision they are observed once every six months, in the administration of medicines. The information recorded in the AQAA included, ‘Through assessment and goal plan work the service encourages clients to develop skills to self medicate, and is monitored in accordance with the plan of care and risk assessment. All medication is held within a non removable lockable cupboard, all record keeping and policies are in accordance with current legislation. A record of all medication including use and side effects is situated in the client’s individual file.’ Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported through policies and procedures to raise concerns and to be protected from harm. EVIDENCE: The commission has not received a complaint regarding this service since the last inspection. The manager also confirmed to us on the day of the visit and in the AQAA that there had not been any complaints made direct to the service. We observed that a copy of the complaints procedure was on display in one of the kitchens of the home, being available for the people who live there. When we spoke to people who live in the home they told us that they felt able to raise concerns with the staff and that any issues would be resolved. The information recorded in the AQAA also included that, ‘The service also offers a grumbles form in which clients grumbles are recorded and acted upon before any situation intensifies and clients are encouraged to discuss concerns on a one to one basis through key working. Individuals who would like to Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 22 complain are advised of anti discrimination codes of practice, highlighting that they would not be victimised and that complaints are seen as a positive response to enable improvements to be made. Advocates are encouraged throughout the service.’ A copy of the policy on protecting vulnerable people from harm was available within the home. If an incident occurred within the home the manager has forwarded a report to the Safeguarding Adults team, has informed the commission and has kept a record of all responses regarding this. When we spoke to the staff they were clear about how to report any concerns and were confident in how they would handle this. They also told us that they had attended training in the Protection of Vulnerable Adults, and staff training records also recorded this. Information in the AQAA recorded that, ‘Clients file checks, accident book checks, client discussion and staff supervision is completed monthly as part of our QA system, which enables monitoring for possible signs of abuse.’ People are supported with their finances and monies are locked away. Receipts are kept of any purchases and records are kept of the ongoing balances of peoples monies. People sometimes go out for a meal, supported by a member of staff. On occasions the individual pays for the staff members meal. The manager told us that this is usually paid for from the petty cash in the home, and it is very rare that an individual pays. The petty cash system should be addressed to make sure that people do not have to pay for staff lunches. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, warm and comfortable home. EVIDENCE: During our visit the manager showed us around the home. There are two living areas, an office, staff room and laundry room. All of the areas were clean, warm and comfortable. There was adequate lighting and the home was free from any offensive odours. People’s rooms reflected their individual personalities, for example, one room had posters on the wall. Some of the bedrooms had been redecorated and some had new carpets fitted. The bedrooms in the Coach House area of the Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 24 home are en-suite. One of these is currently being adapted to make access easier for a person with changing physical needs. A new shower has recently been installed in the main area of the home. However, the manager told us that there are minor alterations required to this before it will be fully available for use. One person told us about their new bed and that they were pleased with this. Some of the people in the home hold a key to their room and details of this is included in their care plan. The manager showed us an annual maintenance plan and records of the maintenance work that has been undertaken. Maintenance problems were identified at the last visit to the home, these included: • No hot water in a bathroom tap. • Flaking paint and exposed floor boards in a bathroom. • Hot water running too hot in a shower. • The room temperature in a double room being too high. • One window did not have an opening restrictor. The manager told us that all repairs had been completed. In addition, during the visit we checked some of the temperatures of the hot water supply and found that these were satisfactory. It was also identified in the last visit that several heavy fire doors banged when they were closing, with the potential risk that they may close on people and cause injury. This was again found with one door, at this visit and the manager was made aware of the need to address this. The information in the AQAA recorded that, ‘The service complies fully with requirement of the local fire service and environmental health. The home continues to have an ongoing safety plan of improvement which includes ongoing maintenance checks, fire system checks, HACCP management system checks etc. Risk assessments through the risk managers system.’ We examined the records and saw that there were certificates for the fire alarm, extinguishers and emergency lights to show that they had been maintained. There were records that fire doors were checked for safety and there was a fire training log. There was a letter to confirm that the local fire officer had visited in October 2009 and that everything was at that time satisfactory. The environmental health officer had visited in October 2009 and the manager confirmed that any recommendations from this visit had been completed. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 25 As there is a separate laundry room, dirty laundry is not handled near food areas. There was a letter in place confirming that the home meets the requirements of the Water Supply (Water Fittings) Regulations 1999, reducing the risks of water contamination and infection. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by well recruited and trained staff. EVIDENCE: We looked at three of the staff records held in the home, including people’s recruitment and training records, and the duty rota. The manager told us that the normal shift is that there are 4 people working from 7 am to 3 pm and then 4 people working from 2 pm until 10 pm, with 2 people sleeping in overnight. She told us that in cases of annual leave or sickness when there are less staff, the shifts are amended to ensure that client activities continue to take place. Recruitment records showed that staff had completed an application form, had had an interview and that the necessary checks prior to employment had taken Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 27 place. Checks on the individual included two written references and a Criminal Records Bureau (CRB) check. This is to confirm that the person does not hold a criminal conviction that may prevent them from working with vulnerable people. In addition, after receiving the written reference, the manager has telephoned the referee to confirm the details of the reference. When we spoke to staff they confirmed the recruitment process and that these checks had been undertaken on them. The manager told us during the visit that people who live in the home have recently commenced being involved in the staff recruitment process. Information in the AQAA recorded that, ‘The service operates a robust recruitment procedure, which is conducted in line with our equal opportunities policy and the protection of vulnerable adults, all applicants complete a full application form to which includes a full employment history, any gaps are investigated and recorded, and a full medical history. Clients are selected through the clients meetings to participate through the interview process which is completed to meet the need of the client (informal discussion, planned questions). The views of the client group reflect the decision through offer of employment.’ There is a staff training and development programme for the home as a whole and in addition there are individual staff training plans. Records of training undertaken are kept and these included: the Protection of Vulnerable Adults, Record keeping, Autism, Fire safety, COSHH, Food hygiene, Infection Control and Administration of Rectal Diazepam. Additionally, there is a staff induction programme which includes details of how it is linked to the Common Induction Standards; these are national benchmarks. When we spoke to staff they told us that they had completed a 3 month induction when they first started to work in the home. This included shadowing a more experienced member of staff and learning what their job entailed. They told us that they had or were completing National Vocational Qualification (NVQ) training and medication training. The manager also told us on the day of our visit that 11 of the 13 staff (80 ) hold an NVQ in care. The information in the AQAA recorded that, ‘The training budget is agreed throughout the managers meetings. However all staff receive a minimum 5 days paid training per year and all staff employed receive a full induction through the common induction standards, which is completed over a 3 month trial period - this includes equal opportunities. All staff complete a training assessment which is reflected along with the aims of the home, individual goals (identified through the 6 monthly performance review) and clients needs.’ Throughout our visit we observed the interactions between the people who live Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 28 in the home and the staff team. The staff consistently responded well and in a respectful way to people. We saw that conversations were positive and at an appropriate level. When we asked the people who live in the home about the staff they confirmed that they were ‘alright’. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by an experienced and qualified manager. They are able to participate in the development of the home and have their safety needs met. EVIDENCE: The manager has worked in the home for some time and told us that they have several years experience of care. The information in the AQAA recorded that, ‘the registered manager holds NVQ 3 & 4 in Care, the NVQ 4 registered managers award, D32 and D33 and over 22 years in the care field.’ Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 30 They told us that in addition to existing qualifications they have updated their training over the last year. They said that courses included: Person Centred Planning, Health and Safety–Risk Assessments and the Protection of Vulnerable Adults. When we asked staff and the people in the home how they would raise concerns in the home they told us they were confident in approaching the manager. There is a quality assurance system in the home that the manager made available to us at the time of the visit. The system assesses how the aims and objectives of the home are met and includes a written report on the results. The assessment includes distributing questionnaires to social services, family and staff members. Additionally the information in the AQAA recorded that the home continues to hold an Investors in People award. We examined some of the maintence records in the home, including the electrical safety certificate, the Gas safety certificate and the Portable appliance testing. These were up to date, showing that these systems had been checked. The information in the AQAA recorded that, ‘Safe working practises are paramount within the service’ and that a risk assessment person is employed by the home. Records were seen of any accidents in the home, and the manager informs the commission of incidents when they occur. One incident involved the calling of the emergency services for someone who lives in the home, for a pre-existing medical condition. On this occasion this was not notified to the commission and it would be recommended that the CQC are notified of these types of incidents. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Version 5.3 Page 32 Sherbutt House DS0000019724.V378199.R02.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 13 (4(a)) Requirement Assessments and appropriate actions must be undertaken to address the risk of injury from heavy doors that may close on people. Timescale for action 27/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA17 YA20 YA20 YA23 YA37 Good Practice Recommendations Records of people’s dietary intake should include details of fresh produce, for example, fruit and vegetables. Hand written entries on medication records should be confirmed and signed by a second person. Tins for the storage of medicines for self medication should be fastened to the inside of drawers or wardrobes. Funds should be available so that people do not pay for the staff lunches on any occasions. Notifications to the commission should include use of the emergency services for ongoing medical conditions. Sherbutt House DS0000019724.V378199.R02.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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