Care Home: Skelton Court

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What the care home does well Staff at Skelton Court have responded well to changes that the service has needed to make to improve the support and care provided to people in residence. Staff interact well with those living at the home, and provide an inclusive environment. We sent surveys to those living at the home, and asked them what they thought the home did well, they wrote:`Good care, food, always helpful.` `Provides nice meals. Organise events and parties etc. Does laundry every day and bed linen every week. Go on outings and walks. They organise games for able people.` We sent surveys to health care professionals and asked them what they thought the home did well, they wrote:`Creates a positive environment. Encourages social inclusion. Attentive to physical and mental health needs. Provides good notes keeping files up to date information for other visiting professionals.` We sent surveys to staff and asked them what they thought the home did well, their comments included:`Caters to the needs of all service users. Supporting and reassuring sometimes in highly stressful situations.` `The home offers a homely environment. Wonderful home made food, ensuring all dietary needs are met.` `The home always celebrates all year for every occasions and delivers good care.` `Care and support for service users and their families.` What has improved since the last inspection? Skelton Court now has a transferred a Manager from another residential home within the organisation to work at Skelton Court on a temporary basis, until the position of Manager is appointed on a permanent basis. The Manager has worked well with the Responsible Individual and put together a plan of action to improve the service provided at Skelton Court. The implementation of this plan, and discussions with those living at the home and the staff employed has enabled the Manager to review practices in the home that have returned autonomy and decision making to those living at the home which has had a direct impact on peoples lives. The position of Manager to the home has been advertised and applications have been received.Staff working at the home have met and been supported by the Responsible Individual and the Manager, this has enabled to express their views and outline what they consider is important to improve the service, which has included identifying training needs. Environmental improvements have taken place, which have included the provision of soft furnishings and furniture, including televisions, and their are plans for future improvements which will include those living at the home having access to a `family room` so that they entertain relatives and friends. Care plans have been signed by those living at the home or their representative, and discussions have started to take place with those living at the home about their care plan and what they want to have recorded, this has also been made possible by individuals living at Skelton Court being asked which staff they would prefer as their Keyworker. Meetings for people living at the home and staff now take place regularly, this enables everyone to influence the day to day running of the home. What the care home could do better: Care plans need further to development to reflect the aspirations, goals and wishes of those living at the home, this will need continued involvement of Keyworkers and training that will enable staff to develop person centred care plans. Additional resources are required to enable those living at the home to access community resources, reflective of their wishes and aspirations. Training for staff needs to be provided in specialist areas reflective of the needs of those living at the home who have an Acquired Brain Injury or Huntington`s Disease to ensure that staff understand peoples needs which they can reflect in the care they provide and the development of care plans. We sent surveys to people living at the home and asked them what they thought the home could do to improve, they wrote:`Staff could interact with the residents a lot more, not just at meal times etc. We sent surveys to health care professionals and asked them what they thought the home could do to improve, they wrote:`Have more staff to enable services users to access local community resources.` We sent surveys to staff and asked them what they thought the home could do to improve, their comments included:`Provide transport for outings.` `Get a mini bus for more outings, which they need and which they love.` `Give us more staff so we can give more care and one to one time, with service users.``We need to have enough staff to take out service users, they are entitled to days out shopping etc and they don`t go on holiday any more.` Key inspection report Care homes for adults (18-65 years) Name: Address: Skelton Court 41 Ryder Road Kirby Frith Leicester LE3 6UJ     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: Linda Clarke     Date: 2 5 0 1 2 0 1 0 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 34 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 34 Information about the care home Name of care home: Address: Skelton Court 41 Ryder Road Kirby Frith Leicester LE3 6UJ 01162321834 01162321835 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.lha.org.uk Leicester Housing Association care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: Categories admitted to `Redwood` No person falling within the categories PD or PD/E may be admitted to `Red Wood` unless that person also falls within category MD or MD/E I.e. dual disability Service User Categories accommodated in `Redwood` No person falling within categories MD/PD or MD/E, PD/E, ie dual disability may be accommodated in `Red Wood` when 10 persons in total of these categories/combined categories are already accommodated in `Red Wood`. Service User Categories accommodated in `` Yellow Acre ``. No person of category MD or DE who is under the age of 50 may be admitted to `Yellow Acre`. Service User Numbers in `Yellow Acre`. No person falling within categories MD, DE, MD(E) or DE(E) may be admitted in ``Yellow Acre`` when 10 persons in total of these categories/combined categories are already accommodated within `` Yellow Acre``. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 10 20 10 10 20 10 Brief description of the care home Skelton Court is a care home providing personal care and accommodation for people aged 50 and over with Dementia and Mental Health problems, including people who have Huntingtons Disease or an Acquired Brain Injury and associated Physical Disabilities. Skelton Court is situated on a modern housing estate within reach of a range of facilities, with a minibus providing additional transport. Skelton Court is single storey and horseshoe in shape; communal facilities consist of a smoking lounge, separate lounge, separate dining room and loungediner. All bedrooms are single and have an en-suite consisting of a toilet and wash hand basin. There is a central courtyard, which is partially paved with seating, a gazebo and mature plants and shrubs. Information is located on site detailing the range of services offered, which includes the Statement of Purpose and Service User Guide. Copies of the Care Quality Commission Inspection Reports, are available on request at Skelton Court. Information about fees is available by contacting the home. Care Homes for Adults (18-65 years) Page 5 of 34 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: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance (AQAA), which is a self-assessment tool, completed by a representative of the service, reviewing previous Inspection Reports, and any information we have received. We sent surveys to people who live at Skelton Court and staff who work at the home. We also sent surveys to health and social care professionals who support people living at the home. We did this to find out there views about the care and services provided. We did this Key Inspection with an Expert by Experience who spoke to people who use the service. An Expert by Experience is a person who either has a shared Care Homes for Adults (18-65 years) Page 6 of 34 experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use the service are central to helping us make a judgement about the quality of care. The Expert by Experience spoke with people living at the home, and observed the interaction between staff working at the home and the people that live there. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Skelton Court. Three people accessing services were selected. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? Skelton Court now has a transferred a Manager from another residential home within the organisation to work at Skelton Court on a temporary basis, until the position of Manager is appointed on a permanent basis. The Manager has worked well with the Responsible Individual and put together a plan of action to improve the service provided at Skelton Court. The implementation of this plan, and discussions with those living at the home and the staff employed has enabled the Manager to review practices in the home that have returned autonomy and decision making to those living at the home which has had a direct impact on peoples lives. The position of Manager to the home has been advertised and applications have been received. Care Homes for Adults (18-65 years) Page 8 of 34 Staff working at the home have met and been supported by the Responsible Individual and the Manager, this has enabled to express their views and outline what they consider is important to improve the service, which has included identifying training needs. Environmental improvements have taken place, which have included the provision of soft furnishings and furniture, including televisions, and their are plans for future improvements which will include those living at the home having access to a family room so that they entertain relatives and friends. Care plans have been signed by those living at the home or their representative, and discussions have started to take place with those living at the home about their care plan and what they want to have recorded, this has also been made possible by individuals living at Skelton Court being asked which staff they would prefer as their Keyworker. Meetings for people living at the home and staff now take place regularly, this enables everyone to influence the day to day running of the home. What they could do better: Care plans need further to development to reflect the aspirations, goals and wishes of those living at the home, this will need continued involvement of Keyworkers and training that will enable staff to develop person centred care plans. Additional resources are required to enable those living at the home to access community resources, reflective of their wishes and aspirations. Training for staff needs to be provided in specialist areas reflective of the needs of those living at the home who have an Acquired Brain Injury or Huntingtons Disease to ensure that staff understand peoples needs which they can reflect in the care they provide and the development of care plans. We sent surveys to people living at the home and asked them what they thought the home could do to improve, they wrote:Staff could interact with the residents a lot more, not just at meal times etc. We sent surveys to health care professionals and asked them what they thought the home could do to improve, they wrote:Have more staff to enable services users to access local community resources. We sent surveys to staff and asked them what they thought the home could do to improve, their comments included:Provide transport for outings. Get a mini bus for more outings, which they need and which they love. Give us more staff so we can give more care and one to one time, with service users. Care Homes for Adults (18-65 years) Page 9 of 34 We need to have enough staff to take out service users, they are entitled to days out shopping etc and they dont go on holiday any more. 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 10 of 34 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 11 of 34 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. Individuals moving into the home can be confident that Skelton Court will be the right home for them as they are encouraged to visit and are involved in the assessment process. Evidence: We wanted to find out how individuals who required residential care can be confident that Skelton Court can meet their needs, we did this by looking at the self assessment tool (AQAA) and records in the home. We sent surveys to people who live at the home, of which two were returned, information in surveys told us that both had received information about the home and had been consulted about moving in. The AQAA which was completed by the Acting Manager told us that since the previous Key Inspection which we carried out on the 26th October 2009 that the home has ensured that individuals considering moving to Skelton Court have had their needs assessed and are invited to visit so that they can speak with staff and those already Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: living at the home. We looked at the records of three people living at Skelton Court, of which two had recently moved into the home, we found that an up to date assessment of needs was in place which had been carried out by a Social Worker, we also found that the homes Acting Manager had also carried out their own assessment of someone who had recently moved into the home, and that the assessment had included the person visiting the home and speaking with the Acting Manager about their care needs. This shows that the home engages with people who are thinking of moving into the home, and provides them with an opportunity to discuss what is important to them, and is seen as good practice. Care Homes for Adults (18-65 years) Page 13 of 34 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. Opportunities for individuals to influence the care and support they receive is encouraged through open dialog which is both individual and collective and is recorded. Evidence: We wanted to find out how people living at Skelton Court influence the care and support they receive and what consultation arrangements are in place to support them with their lifestyle choices. We looked at the AQAA which was completed by the Acting Manager prior to our visit, the information it contained told us that since the previous Key Inspection which we carried out, a number of practices which restricted peoples choices and views had been reviewed, and had been removed from within the home. This had been achieved by reviewing the needs of those living at the home, and discussing with them the areas of concern which were previously highlighted, which included formalised drink rounds and smoking breaks. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: The smoking procedure has been reviewed, and now all but a few people who live at the home maintain responsibility for their cigarettes and lighters. It has been identified by carrying out risk assessments that a few people have been identified as not being safe to manage themselves, and referrals have been prepared reflective of the Mental Capacity Act to ensure that the decisions taken by the home on behalf of those individuals is appropriate. Individuals have been supported with the management of their cigarettes and lighters by discussing the issues individually and collectively in resident meetings, everyone has also been asked to sign a smoking agreement that outlines acceptable behaviour which includes a request for smoking in designated areas only and requesting that people do not light other peoples cigarettes due to safety issues. Drink making facilities are now available in all communal areas, which means that people living at the home do not have to wait for a drink, we observed that staff frequently asked those who are unable to make drinks for themselves if they would like one made for them. We sent surveys to people living at the home, of which two were returned information in surveys told us that both felt that they were to a degree able to make decisions about what they did each day. Everyone living at the home has also had the opportunity to say who they would like as their keyworker, this ensures that people are supported by those they are comfortable with and shows that the views of those living at the home are acted upon. We sent surveys to staff who work at the home, of which seven were returned, information in surveys told us that in the main staff are given up to date information about the needs of those living at the home. We looked at the care plans of three people, and found that they had all been signed and recently reviewed, the Acting Manager told us that all keyworkers are currently working with people to ensure that their care plans were up to date and are written from their perspective, and included their views, aspirations and goals. We found that information in care plans provided clear information as to the role and responsibility of staff with regards to specific care needs such as monitoring of weight and access to health care professionals. Care plans whilst having been reviewed are not as yet written from the perspective of the individual person, the Acting Manager acknowledged this was an ongoing process, and was aware of the need to ensure that all care plans are person centred. The Expert by Experience spoke with several people who lived at the home, and their Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: comments included:Most of the staff are nice, and my keyworker is lovely. The Expert by Experience in their report commented that they had spoken with someone who had recently moved into Skelton Court, and that they didnt like the smoking arrangements, as they couldnt smoke in their bedroom. They told the Expert by Experience that the staff are too bossy however they feel encouraged to do things for themselves. They also spoke confidently about their care plan and said that they were regularly consulted about this. The Expert by Experience spoke with someone else, and their report states that the person when asked about their keyworker said My keyworker is lovely. We looked at risk assessments for the three people whose records we viewed, and found that these were comprehensive and were in the process of being reviewed by keyworkers as part of the reviewing of care plans. Observations of the day were that those living at the home were heard to say Im going to have a cup of tea and a cigarette. This shows that those living at the home are now able to have a drink and cigarette when they choose, which has contributed to a more relaxed environment. Care Homes for Adults (18-65 years) Page 16 of 34 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. Opportunities for people to engage in activities and recreational pursuits are provided; access to activities outside of the home is dependent upon staffing levels. People living at the home benefit from wholesome and varied diet, and have their dietary needs met. Evidence: We wanted to find out what opportunities are available to people living at Skelton Court with regards to lifestyle choices. Information provided within the AQAA told us that recent improvements have focused on the removing of institutional practices within the home, and encourage individuals independence in these areas. The Acting Manager has submitted a financial request to Leicester Housing Association for funding for an Activities Organiser, if this is approved and someone appointed then they will be responsible for organising and providing activities both within the home as well as the community. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: The Expert by Experience within their report commented on the views and comments made those that they had spoken with. One person told them that they are very independent and enjoy going shopping and budgeting their own money and that staff had helped them to enroll on a Construction Course at College. Whilst someone also commented that they were very independent and enjoyed visiting family members. Whilst another person said that they would like to go to Church, however local bus routes on a Sunday meant that this was not possible, they also said that they would like to go to the cinema, this was discussed with the Acting Manager who said they would speak with the person concerned and see what arrangements could be put into place to ensure that their religious needs were met. We sent surveys to people living at the home, of which two were returned, information contained within told us that they feel able to do what they want during the day and evening. We observed in the morning a small group of people supported by staff to make Valentine Cards, several people who were asked chose not to participate, one person said thats for the young, whilst someone else said Ive no one to make one for, so their is no point. We also noted that some people went out to the local shops, whilst others returned from visiting relatives. We did note however that their were those who spent most of the day sitting in the lounge watching television or sleeping. We sent surveys to staff, of which seven were returned a majority of staff stated that additional staff are required if people living at the home are to go out on an individual or group basis. Written comments included:Give us more staff so we can give more care and one to one time with service users. We need to have enough staff to take out service users, they are entitled to days out shopping etc and they dont go on holiday any more. We read the minutes of a recent resident meeting and found that everyone had been asked about where they would like to go on holiday. The Acting Manager said that holidays would be organised for those wishing to go. We sat in one of the dining rooms at lunchtime and noted that everyone was given a choice as to what they wanted to eat, their are always two choices for the main meal, and several choices with regards to a dessert. Minutes of resident meetings show that everyone living at the home has been asked about the menu and whether they have Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: any ideas that they wish to have added to the menu. The Expert by Experience within their report as to the views of those they had spoken with about meals at the home. One person had said It depends whos on in the kitchen, if the right person is working you can have an alternative, but the portions are small. We could also also do with more variation on the menu. Whilst someone else said I love the food and you get plenty. Care Homes for Adults (18-65 years) Page 19 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and welfare of individuals is monitored however the provision of specialist training would ensure that staff have a good understanding of specific health care needs to ensure peoples needs are understood. Evidence: We wanted to find out how individuals living at the home are supported with their personal care and whether their health care needs were met. At the previous Key Inspection that we carried out we noted that records did not accurately record in some instances peoples access to health care professionals and that policies and procedures were not always followed by staff. Information within the AQAA informed us that all staff have been made aware of the homes policies and procedures as to the recording of information and accessing health care services. We looked at records and found that staff now record in greater detail information about a persons day, including any comments or discussion that have had, or any appointments which have been made on their behalf such as with a Doctor or Social Worker. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: We sent surveys to health and social care professionals, of which one was returned. Responses to questions indicate that they are satisfied that peoples health and social care needs are being met, and that the service contacts them when they need advice and that the advice is acted upon. One question asked what they thought the service did well, part of their written response included:Provides good notes keeping files up to date information for other visiting professionals. We looked at the care plans of three people and found that they had been recently reviewed and had been signed by the person themselves of their representative. Information recorded within care plans and records showed that specialist advice has been sought, which for one person has included the assessment and provision of specialist equipment to assist them with activities of daily living. Daily records included information provided when health care professionals had visited. Skelton Court works closely with health colleagues who provide additional support to people with Huntingtons Disease or an Acquired Brain Injury. We identified at the previous Key Inspection that staff needed to receive training relevant to these two specialist areas, the Acting Manager said that this training had not taken place yet, but that consultation had taken place with health colleagues about the provision of such training. A training audit has been carried out by the Acting Manager and has included discussions with staff to identify training needs. We looked at the medication of two people living at the home along with the records and storage of someone who is prescribed a Controlled Drug, we found that the medication and medication records were in good order; staff responsible for the administration of medication have received the appropriate training. Individuals medication is stored within a lockable facility within their en-suite. Care Homes for Adults (18-65 years) Page 21 of 34 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. Individuals living at the home are provided with opportunities to discuss and raise concerns and are provided with information as to how they can raise concerns as detailed within the homes policies and procedures. Evidence: We wanted to find out how peoples rights were supported, and whether people living at the home know how to raise concerns, we also wanted to find out whether people felt safe. We sent surveys to people living at the home, of which two were returned. Information in surveys told us that people know who to speak with if theyre unhappy and know how to make a complaint. The AQAA which we looked at before we visited Skelton Court told us that the home has not received any complaints since the previous Key Inspection which took place on the 26th October 2009. We looked at the minutes of staff and resident meetings and found that the Acting Manager has taken the opportunity at meetings to remind staff as to their roles and responsibilities in making sure that people are safe, and that concerns are reported. Whilst residents have been reminded as to how to make a complaint including how to contact the Care Quality Commission. Minutes of resident meetings and notices which Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: are displayed around the home also advise those living at the home that people living at the home are encouraged to take part in a quality assurance group to focus on developments in the home, in line with peoples wishes and expectations. We noted that throughout our visit residents approached managerial staff to discuss things that were worrying them, these were dealt with promptly with the residents receiving an answer to their query in a timely manner. The Expert by Experience spoke with some of those living at the home and asked them about raising concerns. Their report identified that they had spoken with someone who had recently moved into the home and asked them what they would do if they had a problem with a member of staff or another resident. They said I would keep it to myself. Whilst someone else when asked the same question said I would go and speak to the management team or bring it up at the meetings. The Expert by Experience also found that not some people living at the home are not aware of the role of an advocate or advocacy services. The Acting Manager provided us with information as to planned training which is to take place in February and March 2010, topics include and Safeguarding Alerters course and the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 23 of 34 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. Skelton Court enables people to live in a safe, well maintained and comfortable environment. Evidence: Skelton Court has a small car parking facility to the front of the property, and access to the front door is via an access level ramp. Mechanisms on the front door prevent individuals entering or leaving the building who do not have the access code. Information provided within the self assessment tool (AQAA), which was completed by the Acting Manager told us of improvements that have taken place since we last carried out a key inspection. These improvements have included the refurbishing of the red lounge to include new sofas, furniture and soft furnishings, new televisions have also been purchased. Bedrooms for some living at the home have been decorated, and which has included the replacement of mattresses. The Acting Manager told us that the staff room will cease to be a staff room in the near future and will be used as a family room for those living at the home to entertain their family and friends. We noted that resident meetings had discussed this point with those living at the home who thought it was a good idea. We were also told that the front door bell and staff call bell has been muffled to reduce the noise impact Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: of those living at the home, which we had identified at the previous key inspection as being disruptive to the peace and quiet of those living at the home. All bedrooms have en-suite facilities consisting of a wash hand basin and toilet, communal bathing and showering facilities are adapted to meet the needs of individual with a physical disability, there is a central laundry for the laundering of clothing, and a hair dressing salon for the visiting hairdresser to use. The layout of Skelton Court has a horseshoe shape, with the front doors and offices being in the centre, which then lead into an open plan dining and living space. Each side of the horseshoe is referred to as Redwood and Yellow Acre, both providing lounge and bedroom facilities along with bathing and shower facilities. The two areas provide support for specific needs, but are not exclusive in that people are encouraged to utilise all areas of the home. The lounge located in Yellow Acre is designated as the lounge for people who live at the home who wish to smoke. Communal areas in the home give access to the central courtyard which is planted and provides area of seating. The Expert by Experience in their report wrote that their overall opinion of Skelton Court was that it is kept clean and free of odours. We sent surveys to people living at the home of which two were returned, information in surveys told us that the home is kept fresh and clean. Care Homes for Adults (18-65 years) Page 25 of 34 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. Individuals are supported by staff who have undergone a robust recruitment process and who have access to training, enabling them to provide support and care. Evidence: We wanted to find out whether the care and support people receive is provided by staff who have the relevant training and experience, and who have been recruited using a robust recruitment process. The previous key inspection carried out in October 2009 and an investigation carried out by Leicester Housing Association who own the home identified shortfalls in the way in which the service was managed and the professionalism amongst some staff. As a response to this an Acting Manager has been appointed, who has worked with the Registered Person and has met with all the staff team on an individual and collective basis, and within the AQAA detailed the changes and actions that have taken place. The staff team have been closely monitored and their ability to undertake specific roles and duties has been assessed, this has enabled the Acting Manager to identify the training needs of staff and organsie a schedule of training. Planned training includes Person Centre Plan Awareness, this will help staff to write and develop care plans. Learning Disability and Mental Health and Good Practice in Mental Health, this will help staff to have a greater understanding as to how mental health affects people Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: on a day to day basis and provide them with information as to how to support people well. Training will also include Principles of Care, Communicating Effectively and the Mental Capacity Act. Information we have received told us that 95 of staff have attained a National Vocational Qualification in Care. We sent surveys to staff, of which seven were returned. Information in surveys told us that staff are confident in the training they receive and their ability to undertake their duties. Surveys also told us that their recruitment was robust and that they had to provide two written references along with a satisfactory Criminal Record Bureau (CRB) disclosure, which means that those working with vulnerable adults have been assessed as appropriate to do so. We observed positive interaction between people living at the home and staff, with staff responding to individual requests, and found that staff did spend time with people, conversing and encouraging them to take part in activities in the home. The Expert by Experience in their report recorded that the staff seemed to interact with the residents well with positive body language. Care Homes for Adults (18-65 years) Page 27 of 34 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 Management Team have reviewed systems and practices within the home and have taken into account the views and wishes of those in residence promoting their rights and choices. Evidence: Skelton Court is currently being managed by an Acting Manager who usually works as a Manager in another home owned by the organisation. The position of Manager for the home has been advertised and applications have been received. The Responsible Individual Dawn Cooke had prior to our previous Key Inspection identified shortfalls in the service Skelton Court provides, and along with our findings that we identified in October 2009 have with the Acting Manager taken positive steps to address the issues identified. This had included reviewing practices within the home that support those in residence in retaining responsibility for aspects of their daily lives, and who are encouraged and supported to maintain their independence, without unnecessary restrictions being imposed. Meetings for residents and staff have taken place which has enabled the Management Team, staff and residents to be involved in Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: changes to the home. The AQAA completed by the Acting Manager provides comprehensive information as to what action the home has taken to address issues identified, and also include future improvements which will need to be made to ensure that Skelton Court meets the needs of those living at the home, and promotes their lifestyle choices. Staff have had individual meetings with the Responsible Individual and Acting Manager to ensure that they understand their role and responsibilities in meeting people needs and act in their best interests. We found that daily records are more comprehensive and provide greater detail as to the views of those living at the home, and their achievements and involvement within the home and community. Questionnaires have been circulated to all those in residence seeking their views as to the service they receive, and quality assurance has been discussed at resident meetings, it is hoped by the Acting Manager that some of those living in the home will take an active part in the day to day running of the home and will represent resident views. Information submitted in the AQAA detailed the regular maintenance of heath and safety systems within the home, including fire systems and equipments, central heating systems and emergency call systems. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 6 15 The registered person to 26/12/2009 ensure that care plans are up to date, and where practicable signed by the individual. Care plans should be reflective of the individuals situation, and support their goals and aspirations. Care plans should be reviewed with the individual and their comments recorded. 2 32 19(5) The registered person to 26/11/2009 ensure that staff that are put in a position of authority are competent, experienced, and trained to undertake and fulfil their duties as their role requires. To promote and ensure the health, safety and welfare of individuals living at the home. 3 35 18(1) The registered person to 26/12/2009 ensure that staff have the appropriate training and skills to support people effectively and well who have an Acquired Brain Injury and Huntingdons Disease. Page 30 of 34 Care Homes for Adults (18-65 years) 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 To promote the well-being and health of people with specialist needs which include an Acquired Brain Injury and Huntingdons Disease. 4 39 24 The registered person to 26/12/2009 enable and encourage people living at the home to express their views and opinions, and have their views and opinions once sought acted upon. To enable individuals to influence the service they receive. Care Homes for Adults (18-65 years) Page 31 of 34 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 6 15 The registered person to ensure that care plans are person centred in that they are written from the perspective of the individual and include their aspirations and goals. To enable staff to support individuals to live a lifestyle of their choosing. 31/03/2010 2 35 18 The registered person to ensure that staff have the appropriate training and skills to support people effectively and well who have an Acquired Brain Injury and Huntingtons Disease Staff to be confident and trained so that the specialist needs of some in residence are met and understood. 31/03/2010 Care Homes for Adults (18-65 years) Page 32 of 34 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 12 Care plans to include individuals aspirations and goals with regards to employment, education, work placements and work training schemes. Care Homes for Adults (18-65 years) Page 33 of 34 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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