Care Home: Shula`s

What the care home does well This is a very family style, homely service. The environment is cosy, well furnished and clean. All the tenants are encouraged to live as independently as possible with risk assessments and the correct support aiding that independence. All the tenants live an active and independent lifestyle in both the community, at `Patches` the companies head office and at various day activity centres for both work and education. Staff are very well trained and value the job with all the support offered to develop their roles. There is a good level of staff within the home to ensure tenants who may need more one to one support have this when required. All the tenants take part in their person centred care plans and review them regularly with the staff. Picture formats are used well to ensure that the information about the person is understood by them. What has improved since the last inspection? The home is continually reviewing and improving the care provided with development plans available to discuss and update as progress happens. The Manager now has a comprehensive building check list to cover all areas of the home to ensure the building is of a high quality and safe. The home environment is continually improving to create as much of an independent living style type home as possible yet still keeping the character of the house. What the care home could do better: This home is an excellent service but should register the Manager with the Commission as soon as possible. Records of checks could be improved by a more methodical recording done room by room, such as the thermostatic valve checks on the hot water system. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shula`s 9 Cadogan Road Cromer Norfolk NR27 9HT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Hannent     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Shula`s 9 Cadogan Road Cromer Norfolk NR27 9HT 01603279222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Jeesal Residential Care Services Limited care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 An ensuite shower and handbasin to be provided for the bedroom on the first floor within three months from the date of the registration certificate. Date of last inspection Brief description of the care home Shulas is a Care Home for six adults with a learning disability. The accommodation is divided into two units for three people upstairs and three down. There are six single bedrooms with each person having their own bathroom facility. Two bedroom are on the ground floor one is on the first floor and three on the second floor. There is a shared lounge, kitchen/diner and additional toilet on the ground and first floor. There is no garden but a small paved area to the rear of the flat. The aim of the Home is to promote independent living. The Home is managed by the Manager of Lilas House, which is a Care Home owned by the same organisation and is three doors away. The fees for 2009/10 are from £500 to £1052 according to need. Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 key inspection visit took place over 4 hours on the 7th May. This report has been completed following that visit. Other information used to complete the report has been taken from comments received from tenants and staff and the Annual Quality Assurance Assessment (AQAA) completed by the Manager, received at the Commission prior to the visit. Records were looked at, staff and tenants were spoken to and a walk around the home took place. Care Homes for Adults (18-65 years) Page 5 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 26 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 7 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Any potential tenant will be assessed and other tenants consulted to ensure the home is a suitable place for that person to live in. Evidence: The home has information in suitable language and picture formats to share with any interested potential tenant. The information is held by all tenants in their personal boxes in their rooms. The home has not received any tenants that were not already known to the home for a while. One person was admitted from another home within the company and is known well by the organisation. The AQAA tells us that a comprehensive assessment is taken with an application form to the potential tenant. The organisation will also send a Behavioural Support Manager to visit the person and any additional training that may be required to meet the needs of the person will be provided once the home has decided the needs for that person can be met. Care Homes for Adults (18-65 years) Page 8 of 26 Evidence: The Manager talked of the home with supported style living has to be suitable for the person moving in and who is able to share some of the home with other tenants. These other tenants are consulted and considered when a new person is considering moving in to their home. Care Homes for Adults (18-65 years) Page 9 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The tenants have a person centred care plan and actively contribute to their personal goals and aims planned for. Risk are identified and assessments written to support tenants in their independent lifestyles. Throughout all the planning and choice making confidentiality is treated correctly and confidences are kept. Evidence: On discussion with tenants and the details seen written in the person centred plans of care the tenants are actively involved in every aspect of their day to day lives. The plans were noted to be regularly updated and that tenants signed the documentation to show their involvement in the planning of their care. All the comment surveys received at the Commission prior to this inspection visit were all ticked with a yes to the question about being involved with decisions about their lives. The tenants spoken to talked of the forum meetings that take place away from the home to voice their Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: thoughts and choices. We are always listened to and any concerns will be helped with were just some positive comments voiced by the tenants. The conversations listened to, were all around the person and their abilities and the need for individual care support to promote their independence. Throughout all the conversations, the respect and confidentiality of the person was taken into account. The tenants have all the details relating to them kept in their own rooms and only on asking if we could look at their paperwork did a tenant share the contents of their personal files with us. Each care plan also held risk assessments that related to any form of activity that may present a risk and these had review dates to show they were up to date. Care Homes for Adults (18-65 years) Page 11 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tenants take part in community activities, education and leisure activities as enjoyed by that person. Day to day routines are planned and structured to suit the needs of the tenants. Meals are chosen and eaten when and where preferred with treats held in the persons own fridge. Evidence: The individual plans of care and support talk of the day to day activities that each person is involved in. The AQAA tells us that to support each tenant appropriately professionals are used from teams such as Psychologist or Learning Disability Team. Places are sort in further education for those who wish to take part. One tenant talked Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: of the groups attended for Maths and English. On the day of this visit one person was going out on a shopping trip to buy another tenant a birthday present, another was off to the supermarket to get the treats that are placed in the fridge in their own room. One tenant showed us the picture of his friends at the local church that he used to attend. Lots of conversation with a number of tenants were discussed around trips out to the local facilities such as the local cafe to the cinema and theatre. Photographs in personal folders were seen and discussed around the holidays in Great Yarmouth and the planned trips that are to occur again at the end of May. Help has been provided for a person who would really love to have a dog, by time offered in the local dogs home where the tenant can help look after the dogs by walking, feeding and grooming them. Details on the way the tenants clean and care for their own rooms was discussed with three people. Each one told of the routine carried out for cleaning, stripping beds, shopping etc. No staff member entered a tenants room without being invited in and each tenant had a key to lock and unlock their room as they so wished. Some tenants also have a main front door fob to release the main door. These have been issued only after a risk assessment has been carried out. (Risk assessment seen). Meals and meal times are usually structured and timely to meet the needs of tenants who need, as part of their care, a strict and structured daily routine. The meals eaten are recorded in the daily diary and the choices are made by each tenant. One tenant was planning the meal for that evening and was shopping and cooking the meal for three of the people she shares her home with. The three people upstairs need more support with the cooking of their meals but do help as best they can with preparation and washing up. The lunch on the day of this inspection was a sandwich of choice and a yogurt with a lasagne planned for the evening meal. Anyone can come and go in the kitchen and have a drink as and when they like. There is a dining table in the sitting room, a kitchen table in the main kitchen offering choice as to where the person would prefer to eat. The menu of the day is on display in the kitchen with picture formats on the notice board to help understanding. The Manager told us the home is working with dieticians in the support of managing weight concerns with one person. This is proving difficult but the home is exploring various avenues to help this person. Care Homes for Adults (18-65 years) Page 13 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal, health and medication support for the tenants is managed discretely, recorded thoroughly with aims for independence being strived for. Evidence: The support required for any tenant who needs personal care is documented in the persons own care plan. One person was able to tell us of the care support given and how good the staff team are in giving that support. Problems had arisen through the night, according to this person, that have been addressed by specialist equipment placed in their room. This has preserved dignity and we were told by this person how pleased they were with the way the problem has been managed. The tenants are all registered with the local GP practice and will receive help from any specialist that will support the tenant, such as the Continence Advisor, CPN or Psychologist. Each person has a small hard back health folder that has the record of all health needs, appointments and action required to ensure good health is monitored and recorded. One person showed us the recent specialist appointment attended and the record made in their health folder. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: The home has a metal medicine cabinet in the office/sleeping in room for storage of some medicines but the current medication is stored in each tenants own medication cabinet in their individual bedrooms. One person showed us in their cabinet and the medication administration charts. We were told by this tenant that the staff always help with the medication. A risk assessment confirmed that self administration would be too risky. The AQAA tells us that the home is aiming to give some tenants the management of their own medication but a comprehensive risk assessment needs to be carried out. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The tenants will be listened to and will concerns acted upon. Tenants can be assured that they are protected from abuse by the homes policies and procedures being adhered to. Evidence: No complaints about this service have been received at the Commission nor by the Manager of the home . The complaints procedure is on display and all tenants spoken to felt they could go to the Manager or Assistant Manager and that they would be listened to and any problems would be resolved. The comments received prior to this inspection were all positive with nothing but praise for the home. I can always talk to the Manager she listens and tries to help me. The tenants also have the opportunity to voice any concerns at in-house tenants meetings and at the regular Forum meeting held in Norwich. This was positively talked about during the inspection by both staff and tenants. The Manager is a very hands on person who knows the tenants very well and will recognise the signs if someone is unhappy. The AQAA tell us that recent support from the Psychologist has helped with the clariflying of what was a misunderstanding and the concern was resolved quickly. The home have a whistle blowing policy that the staff talked about. Each member of staff has to read the policy twice a year and sign to say they understand the policy. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: The Manager stated that no staff member commences work without a POVA and CRB in place. This was confirmed by the staff member on duty whos personnel folder was looked at and evidence was found of these checks. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is bright, homely, comfortable, suitable and safe for the tenants who live there. Evidence: The home is a converted Victorian style house in the town of Cromer. It has undergone a number of changes as time has moved on with three tenants living upstairs and three down. Each floor has its own living/dining/kitchen space shared by the three people. The bedrooms have their own small bathrooms with tenants choosing to have a bath or shower installed. On the ground floor an area has been created to give one tenant a large wet room to meet the needs. Three bedrooms were seen in total. Each one was very different and reflected the needs of the individual. One room has a number of calendars and clocks that are very important to this person another person has moved upstairs which was their choice and is very happy with the room. Everywhere was very clean and tidy. The tenants were very pleased to show their rooms to us and explained how they help keep the rooms clean. Certain days for certain tasks is very important for the tenants and they take pride in what they do to keep their home looking nice. The communal areas are homely and have comfortable furniture. In the upstairs Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: lounge there is a chair that also gives the tenant a massage while watching the television. The tenants come and go from room to room as and when they like. The tenants have their set days for washing. One tenant explained on what day the sheets are changed and on what day the clothes are washed. Routine is very important to this person and if the routine is not followed problems can occur. This was very clearly stated in the care plan and also explained to us on the day of this inspection. One person has special washing detergent due to skin problem and told us of the special liquid used just for him. There is a washing machine on each floor and all the clothes were fresh, clean and ironed. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Competent, capable, trained and experienced staff are employed to offer care support that is suitable to meet the tenants needs. Evidence: The AQAA tells us that the Manager has a team of staff who are competent, motivated and qualified to support the individual tenants needs. The two staff spoken to on the day of this inspection were confident and informative with the tasks they are asked to perform. Each one gave clear discriptions of their roles and through observation were able to offer the care support to meet the individuals needs. The qualifications of the staff team are high. The Manager gave clear details of how the team are supported to gain their NVQ qualifications. The new staff have a comprehensive induction which was discussed with one staff member and development files for all staff were seen that included induction programmes. Each shift has two staff and the Manager on duty with a sleep in staff member overnight. For the needs of the tenants this is suitable staffing levels. The staff say the tenants sleep well at night and a need for waking night staff is not necessary. The recruitment of staff, according to the Manager, is a robust procedure to ensure the Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: right people are employed in the home. Personnal files were seen and references looked at, and applications showed a high standard of staff were being employed. POVA and CRB checks were in place along with 2 forms of identification and 2 references. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The tenants benefit from a well run, safe home and whos views are listened to acted upon by giving a service that is looking to improving and developing all the time. Evidence: This Manager is an open and capable person who listens and reflects on suggestions. Throughout the day it was evident that this person takes pride in her work and has a good balance between the caring role and the administration/management role required. The home is regularly looking at ways to develop and improve. The development plan is on display in the kitchen for 2009 (read) and tenants are regularly participating in various forums to air views and plan future developments for their home. The Manager informed us that she is not registered with the Commission to date but an application is pending. The recognised Management qualification is also in the process and according to the Manager should be completed in the next few months. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The home has all policies and procedures in place for all staff to access, and some policies such as whistle blowing are read every 6 months with staff signing to say they have read and understood the policy. The Manager, on talking, is very careful in writing and recording any information, offering training and writing risk assessments that will ensure all tenants and staff are protected. On the day of this visit sample checks were seen that is the managements responsibility. Seen and discussed were the fire alarm checks, risk assessment both for individuals and the building, COSHH safety data sheets and, what has recently been introduced is the Manager checklist. Al records were current and signed. It was noted that although the water temperatures had been checked to ensure the thermostatic valves were working correctly a note of which room had been tested was not shown. Anyone testing the water could be doing it in the same room and therefore not getting a true picture of all valves. The home has regular contact with the companys Maintenance Officer who keeps the home repaired and carrys out small jobs. The contacts for any major jobs or emergency numbers are available at all times. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 42 It is recommended that thermostatic valves are tested and the room recorded to ensure all areas accessed by tenants are checked on a regular basis. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!