Care Home: South View (30)

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What the care home does well The expert by experience said, "Overall, I think the home worked in the best interests of the people who live there, and even though it was quite small, it felt homely and welcoming. Both service users I spoke to said they were happy, they liked living there and that they wouldn`t change anything about it. I would choose to live there because they get choice and I could see my friends and family often, and get the opportunity to access education." People who move to the home have their needs assessed in detail by social or healthcare workers and the manager so that everyone is sure that this is the right place for them to live. This is very important where people have complicated care and lifestyle needs that require well-managed and agreed ways of supporting them. Staff help people to have interesting lives, they help people to take part in activities they like and they help them to find and try new ones. The staff and manager help people to make choices about their lives and support them to be as safe when they want to do something risky. The staff work well as a team. Staff are trained so that they have the skills they need to support the care and lifestyle needs of people living at the home and there are sufficient staff available so that these needs can be met. The manager and staff have the experience and training to run the home effectively so that the best interests of the people who live there can be met. And people are asked about the way they wish to live so they have control over the way the home is run and are listened to if they have concerns. Care is provided to people with a different needs, varied ages, expectations and backgrounds. Both care practice and staff recruitment practices are governed by equal opportunity principles. Peoples` bedrooms are private and they can make them their own with furniture and possessions if they want to. There is a talented and enthusiastic manager at this home and a good track record in other services. She has only been in charge of this home for several months and can already demonstrate the improvements that have been made and can show firm plans about how the home will be developed. She has the confidence of her manager and people using the service find her approachable and fair. The manager has strong principles about how the organisation should support peoples` rights and empower them as valued citizens. She is enthusiastic about their work and can demonstrate how she intends to gives good quality, person centered care and support for the benefit of the people who live at this home. The owners and manager are good at recognising and researching where improvements need to be made. They ask people for their views and have already drawn up plans about how they wish the home to improve and develop the quality of service they provide for people living at the home. Some of the changes had already been put in place by the time of this inspection. What has improved since the last inspection? This is the first Key inspection of this home. What the care home could do better: There are no areas that have been identified as falling below the National Minimum Standards. However there are improvements which have been identified which would enhance the quality of life for the people at the home. The manager should make sure that the review and improvement of care plans is completed so that they describe in detail how staff will meet peoples needs and coordinate staff`s best practice. The manager should make sure that the review of how people are supported to take risks and how safeguards and judgements are written down, is completed. This is so that there is a detailed plan in place which shows how staff have promoted independence and safety. The manager should encourage staff to make sure that public transport and taxis are used to help people who need assistance to lead more active lifestyles. The manager should continue to put in place improvements in the way that medication is held and administered in the home so that people get the treatment they have been prescribed and mistakes are avoided. The manager should carry out the planned refurbishment / redecoration of the home including improving the kitchen and the laundry and completing the bathroom refurbishment. Key inspection report Care homes for adults (18-65 years) Name: Address: South View (30) 30 South View Annfield Plain Durham DH9 7UB     The quality rating for this care home is:   two star good 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: Steve Tuck     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: South View (30) 30 South View Annfield Plain Durham DH9 7UB 07734193907 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lifestyles - Care and Support Ltd Name of registered manager (if applicable) Mrs Tracey Dodds Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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: Although it has been open for over 5 years, this is the first inspection by the Care Quality Commission while the Lifestyle Care and Support have owned the home. Before the visit we looked at: Information we have received since the present owners took over. How the service dealt with any complaints and concerns since then. Any changes to how the home is run. The providers view of how well they care for people. We asked them to examine their Care Homes for Adults (18-65 years) Page 5 of 33 own service and write to us with the results. We sent surveys to people who use the home, people who arrange for residents to live there, those who visit the home to support people like doctors and therapists and the staff who work in the home, to ask what they think about services there. We arranged for an expert by experience to join us for this inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Visit An unannounced visit was made on 29th September and another visit on 5th October 2009. We asked an expert by experience to take part in the inspection, in particular to talk to people who live at the home to see what life is like for them. She spent around four hours at the home and wrote a report about what she had found. The findings of her work have been used throughout this report. During the visit we: Talked with the people who use the service the staff, the manager and visitors to the home. Observed life in the home. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people Care Homes for Adults (18-65 years) Page 6 of 33 they care for. Looked around parts of the building to make sure it was clean safe and comfortable. We told the manager what we had found. 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. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: The expert by experience said, Overall, I think the home worked in the best interests of the people who live there, and even though it was quite small, it felt homely and welcoming. Both service users I spoke to said they were happy, they liked living there and that they wouldnt change anything about it. I would choose to live there because they get choice and I could see my friends and family often, and get the opportunity to access education. People who move to the home have their needs assessed in detail by social or healthcare workers and the manager so that everyone is sure that this is the right place for them to live. This is very important where people have complicated care and lifestyle needs that require well-managed and agreed ways of supporting them. Staff help people to have interesting lives, they help people to take part in activities they like and they help them to find and try new ones. The staff and manager help people to make choices about their lives and support them to be as safe when they want to do something risky. The staff work well as a team. Staff are trained so that they have the skills they need to support the care and lifestyle needs of people living at the home and there are sufficient staff available so that these needs can be met. The manager and staff have the experience and training to run the home effectively so that the best interests of the people who live there can be met. And people are asked about the way they wish to live so they have control over the way the home is run and Care Homes for Adults (18-65 years) Page 8 of 33 are listened to if they have concerns. Care is provided to people with a different needs, varied ages, expectations and backgrounds. Both care practice and staff recruitment practices are governed by equal opportunity principles. Peoples bedrooms are private and they can make them their own with furniture and possessions if they want to. There is a talented and enthusiastic manager at this home and a good track record in other services. She has only been in charge of this home for several months and can already demonstrate the improvements that have been made and can show firm plans about how the home will be developed. She has the confidence of her manager and people using the service find her approachable and fair. The manager has strong principles about how the organisation should support peoples rights and empower them as valued citizens. She is enthusiastic about their work and can demonstrate how she intends to gives good quality, person centered care and support for the benefit of the people who live at this home. The owners and manager are good at recognising and researching where improvements need to be made. They ask people for their views and have already drawn up plans about how they wish the home to improve and develop the quality of service they provide for people living at the home. Some of the changes had already been put in place by the time of this inspection. What has improved since the last inspection? What they could do better: There are no areas that have been identified as falling below the National Minimum Care Homes for Adults (18-65 years) Page 9 of 33 Standards. However there are improvements which have been identified which would enhance the quality of life for the people at the home. The manager should make sure that the review and improvement of care plans is completed so that they describe in detail how staff will meet peoples needs and coordinate staffs best practice. The manager should make sure that the review of how people are supported to take risks and how safeguards and judgements are written down, is completed. This is so that there is a detailed plan in place which shows how staff have promoted independence and safety. The manager should encourage staff to make sure that public transport and taxis are used to help people who need assistance to lead more active lifestyles. The manager should continue to put in place improvements in the way that medication is held and administered in the home so that people get the treatment they have been prescribed and mistakes are avoided. The manager should carry out the planned refurbishment / redecoration of the home including improving the kitchen and the laundry and completing the bathroom refurbishment. 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 33 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 33 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. Each persons needs are assessed before they move in which helps to make sure that these can be met at the home and inappropriate admissions are avoided. Evidence: Since Lifestyles Care and Support took ownership of the home the written information called the Service Users Guide which gives all of the important details that people need to know about what it is like to live there, has been changed. This includes information about how to make a complaint and the most recent Inspection report. The Service User Guide for this home has been drawn up in ways which help people to understand what the information means and staff also help to explain it. This includes the amount of money the home presently charges so that people know how much their care costs. No new people have moved to this home since Lifestyles Care and support took over ownership. But we can see from existing records that each persons needs have been assessed before they move to the home by a team of workers such a social worker, a community nurse, a psychologist, as well as the manager. This is to make sure that Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: the home is suitable for meeting the needs of people who are going to live there. The manager is carrying out a review of each persons needs to make sure that the home is able to successfully support people who live at the home and make sure staff are using current best practices. Discussions with the manager and staff show that they have have found out about the cultural and lifestyle needs of people who wish to move to the home to make sure that these can be met. All peoples assessment information has enough information in it so that staff can start to plan and write down the ways that they are going to support them. This is important where people have complicated needs which require a lot of insight and well-organised support. Care Homes for Adults (18-65 years) Page 13 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has an individual plan of care, which sets out their preferences and how their assessed needs will be met. The descriptions of the measures which staff use are being improved so that they can consistently meet peoples needs. Evidence: All people living at the home have a plan of care, which gives a description of how their physical, emotional and lifestyle needs are to be met. Since the present owners Lifestyles Care and Support have taken over, the new manager has carried out a comprehensive review of care planning arrangements and has put measures in place to improve them. These measures include, updating information about how people are to be supported, particularly where people have needs which are complicated or behaviour which is difficult for staff to manage. For example, some people at this home have needs which require the staff to respond to them in particular ways for example to give them support to feel confident and help them to manage their anxieties and care plans need Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: to give accurate and up to date descriptions of how staff are to respond. Other improvements that the manager is making to care plans include making them easier to use by staff and making them more relevant to peoples lives. People are supported by staff in an individual way and tailored to their specific needs so that they can live as valued citizens within their community. Care is carried out in ways that are arranged so that individuals are at the centre of a network of support and tailored so that people have individual lifestyles. Staff have an understanding of peoples background, needs and preferences which they need to be able to successfully support people. The manager has made sure that there are good links with other community based health and social support staff to make sure that their care is coordinated. This is particularly important where people have needs which require support to occur in particular ways, for example if someone is challenging towards staff or has emotional difficulties. The way that care plans are written down does show that peoples needs are now better identified. Care plans are organised and contain most of the relevant information that staff will need to help them to support people consistently. The way that people are to be supported is written down in enough detail and there are reviews to see if their needs have changed. The changes in care plans demonstrate that people living at the home are starting to be supported by staff in ways that helps them to feel in control and confident and this work is beginning to be written down. So that the improvements continue, the manager is planning a training programme for the staff team who it is planned, will become more active in care planning arrangements. People living at the home are treated with respect by staff who know them well. Relationships between people and with staff are relaxed, friendly and informal which helps them to feel comfortable. People appeared to be relaxed and happy with the support they get from staff. Staff meet together at the start of each shift where they talk to each other about peoples needs so that they remain up to date, work well as a team and remain consistent. The expert by experience said, When I spoke to (staff) she had a good knowledge of the service users and what they liked to do. She was good in promoting choice and independence, asking them what they would like to eat or what they would like to do. All people living at the home have access to someone outside of the home who can speak on their behalf and help to make decisions in their best interests. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: The manager and staff help to make sure that people have as many opportunities as they can. To make this happen the manager and staff have helped people to be as independent as they can and to take measured risks if they wish. The manager and staff take steps to support people and help reduce risks so that that there is a balance between promoting peoples independence and rights and making sure that they are safe. The manager is taking steps to make sure that records of how risks have been considered are clearer for example, the safeguards staff put in place when people decide to stay out late or at friends homes. Care Homes for Adults (18-65 years) Page 16 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported by the staff to make choices about their lifestyle so that they can lead fulfilling and interesting lives and staff help people stay in touch with their circle of family and friends so that they can keep links with people outside of the home. Evidence: Some people who live at this home have active lifestyles, with their own routines and activities many of which occur outside of the home. The staff help people to choose activities that they would like to take part in or to try out and to find out about things that they might be interested in and arrange them. Staff also encourage people to make decisions, and help them to organise their time. Examples of opportunities include shopping, college courses, walks and daytime opportunities run by the council. The expert by experience said, Through talking to staff and service users I found out that the service users are involved in leisure activities such as tai chi, swimming, Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: walking, shopping, watching television, playing snooker, darts and board games. They also go to the Quest Club twice a week and (some) service users go to college. There are some people who are planning to get qualifications which will help them with work for example recognised childcare qualifications. The expert by experience also talked to people about their holidays. She said, The service users had just returned from a holiday to Haggerston Castle, it was their choice where they went and they really enjoyed it. I looked at photos from a holiday in Blackpool, a Halloween party and a trip to Beamish. Some people are also able to take holidays on their own with support from staff. Staff at the home help to plan how individual support for the people living there is to take place so that their choices and event commitments can be met. However staff do not yet make best use of public transport and taxis to help those people who need staff support to take part in opportunities. Some people who live at the home have had the opportunity to take part in activities and become more independent. Staff and the manager have supported them by making sure that the risks that people take have been reduced and where possible safeguards are put in place. The manager is currently working with staff to make sure that these follow best practice guidelines and are written down in a way that is accurate and clear. Staff find out about some opportunities or activities which are taking place in the local and wider community and try to make sure that support and transport is available for those people who want to take part. There are descriptions in peoples care plans and photographs of people taking part in activities and during visits are displayed. For example there were photographs of the places that people have visited and when celebrations have been held. Staff help people to keep in touch with friends and relatives and some people visit each others homes. Several choices of meals are offered at all times and people help to plan their menus. Attempts to offer a balanced diet whilst still responding to peoples choices were noted. Although there is a menu, people living at the home are able to choose different meals depending on their preferences and the manager makes sure that there is sufficient stock of favourite foods. Some people also decide to make their own arrangements and use local cafes or takeaways. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: The expert by experience said, The service users have a lot of choice in what they do. They go shopping with the staff and buy food according to what theyve planned in their menu. The deputy manager said that sometimes they end up cooking different meals for everyone as they want something different. I think this is good though because they get to choose what to eat. The staff also said there are always snacks available in between meals. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are identified and arrangements are in place to help make sure that they can have a healthy lifestyle. Evidence: Records of peoples healthcare needs are kept by staff in care plans. These show that staff look out for changes in their physical or emotional state which may need the involvement of specialist healthcare workers from outside the home. This has promoted joint working with healthcare staff and helped home staff make sure that people get the healthcare support that they are entitled to and also to put in place approaches for people whose needs are difficult to meet. People are registered with healthcare facilities for example their general practitioner or dentist and are supported to attend appointments if they wish. Any personal care is carried out in private with staff encouraging people to be discrete where this is required. Some people who live at the home are not able to administer their own medicines, and designated staff therefore assist in this area. Some people take responsibility for Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: their own medication for example for overnight stays. The manager has weighed up the risks and taken steps to minimise the likelihood of harm. Overall Medication is securely stored and there are systems in place which should help to minimise mistakes. Medication is checked by the deputy manager and the senior manager visits to make sure that the home is supporting people successfully including their medication. The manager confirmed that staff at the home have been trained to help them to be able to administer medication. However one prescribed medication was out of date and records about its administration could not at first be found. The manager said that this medication did not need to be taken regularly and had not been administered for over five months. Before the end of the inspection she had reinstated the records, received clarification from the doctor and ordered a new stock of medication. The manager confirmed that she is to change the way that medication is to be stored and administered at the home. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home and their families can make a complaint if they are unhappy, have a grievance or dispute which helps them to have control over their lives and there are measures in place which protect people from being harmed which helps to promote their safety and security. Evidence: There is a clear complaints procedure in place at the home, which tells people how to complain, and the length of time a response will take. By watching staffs day-to-day work we could see that they ask for the views of people living at the home all the time and help them to make choices and decisions. People who live at this home assert their views and preferences and were clearly empowered to say what they thought. The expert by experience talked to people about complaints and said,When I asked the service users who they would go to if they had a problem, they both said they would go to the staff, and one service user she said shed go to the manager too. She also said she would tell someone if she didnt feel safe, and that things were made easy to understand for her in her home. Although no one had decided to use the complaints procedure to resolve their grievances in the past 12 months. The manager showed that she knew how to record and take forward complaints if this was needed. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Since the last inspection there have been no instances where abuse was suspected at the home. The homes adult protection procedure is robust and complies with the Public Disclosure Act and the Department of Health Guidance. There is a staff guide, which gives clear instructions about the actions which they must take if abuse is disclosed or witnessed. All staff spoken to are knowledgeable of these practices and have had training. Care Homes for Adults (18-65 years) Page 23 of 33 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. The house is homely and clean and provides people who live there with a comfortable environment in which to live although this could be improved if the house was refurbished and redecorated. Evidence: People who live at the home are encouraged to keep their own rooms tidy and they are helped by staff when this is needed. The home is kept clean by staff who take effective steps make sure that the home is well maintained. The house is in a street of similar properties and has had adaptations made so that it is suitable for its present use. The home fits in well with those around it which helps people who live there to be accepted citizens within their community. There have been only a small number of changes made to the home in the past although the present owners are planning some improvements. These include, a redesign of the kitchen and laundry and improvements to the bathroom. There is one main bathroom at the home which is accessible for the people who presently live at the home to use easily. Everyone has their own single room and people are able to lock their bedroom doors Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: so that they can have privacy. The bedrooms are pleasant areas, which have a range of furniture, and fittings which people have chosen and are comfortable and useful to them. All of the people living at the home have decorated their rooms with their items, photographs and keepsakes and some have bought their own furniture and soft furnishings. The home is inspected by the Fire Prevention Service and overseen by the local authority to make sure that risks from an accidental fire are lessened and a safe and healthy environment is promoted for the people who live and work there. There is evidence that recent repairs and maintenance have been carried out when the new owners took over the home. And the manager has drawn up a refurbishment programme to improve those areas that are now looking dated. Care Homes for Adults (18-65 years) Page 25 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff at the home to support the people who live there. And they have the skills, training and support from the acting manager so that they can meet the needs of people living at the home. Evidence: Information from the manager indicates that staff have received training relevant to their job roles and the needs of people living at the home. A training programme is in place which encourages staff to develop skills and remain motivated by the work they do and helps to improve the quality of the service. This covers National Vocational Qualifications (NVQ) as well as specialist courses which address the needs of the people who live at the home. At present over three quarters of the care staff have NVQ Level 2 or above. New staff are given extra training which links with national training organisation standards so that they have sufficient skills to support people and work effectively with other team members. Some people living at the home have complex support needs and additional staff are available so that support can be successful and safe. Although this is a small staff team, care workers are organised with shift patterns which reflect the demands of people living at the home and records show that sufficient staff have been working Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: there. This work pattern reflects the times of the day when people need the most support, for in the evenings and weekends. After talking to people the expert by experience said, Both service users said that the staff were nice, that there was enough staff and they knew who was going to be working. Staff demonstrate that they know about most aspects of peoples care needs and the strategies and approaches they use to support them. By watching what staff do we could see that they understand their role as care practitioners and try to have a good standard of practice when they support and interact with people living at the home. Although not all staff were fully aware for example, the expert by experience said, When I asked (staff member) who went to college, she told me that two service users went but didnt know what they were doing at college. One service user knew who her key worker was, but the other said he couldnt remember who this was. Staff have regular contact with their senior manager and the manager at present works alongside them on a day-to-day basis. The manager has records which show that regular supervision has been organised now that Lifestyles Care and Support have taken over, where staffs performance and the work they do with individuals is thoroughly discussed. Morale is generally good at the home and staff are conscientious about the work they do. The expert by experience said,The staff were friendly and seemed to have good relationships with the service users. When I spoke to the deputy manager she had a good knowledge of the service users and what they liked to do. She was good in promoting choice and independence, asking them what they would like to eat or what they would like to do. When another staff member showed us around, she showed us the bedrooms without asking for the occupants permission. I think she should have asked them first because it wasnt protecting their privacy. However, when I asked the service users if staff knocked before entering their room, they said yes. The manager confirmed that all new staff have had checks carried out before starting work to make sure that they are suitable to work with vulnerable people and where these have taken place some time ago, additional checks will be carried out. Care Homes for Adults (18-65 years) Page 27 of 33 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. There are new owners and a talented hardworking manager at this home who makes sure that people who live there are supported properly and gives leadership and direction to staff so that the quality of the service they give is improved. Evidence: The new owners, Lifestyles Care and Support have appointed a manager at this home who has extensive experience and an excellent track record in managing care services. She is presently managing two other services for the company as well as this one. She has worked in residential care services for 18 years and has been a Registered Manager for the last 4 years. She has completed the Registered Managers Award [National Vocational Qualification] Level 4 and a Health and Social Care NVQ also at level 4. The manager has extensive experience and skills in supporting the needs of people with learning disabilities in this and other community settings. The manager has been assessed by the Care Quality Commission to make sure that she has the skills qualities, experience and knowledge to properly run the service. Since taking over the management role at this home, she has shown that she has the Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: capacity to organise and develop the service. This reassures people living at the home and their relatives that the service can continue to be provided in their best interests. People living at the home are empowered to give their views about all aspects of the support they get from staff. There are a number of meetings held at the home and also other informal occasions where the manager and deputy are able to check that people are satisfied with the service. The manager also collects the views of peoples families and friends, social work and healthcare staff who visit the home so that he can check to see if the service is meeting the needs of all parties. This helps the manager to monitor progress and develop the service. The results of this work are organised in a way which shows how the management improvements at the home are planned around the comments that people make and the checks that the manager carries out. The expert by experience said, Overall, I think the home works in the best interests of the people who live there..... it felt homely and welcoming. Service users I spoke to said they were happy, they liked living there and that they wouldnt change anything about it. I would choose to live there because they get choice and I could see my friends and family often, and get the opportunity to access education. Staff at the home help people who live there to manage their money. Detailed records are kept of peoples day to day finances and where staff have supported them to make purchases. Information is also available to people who live at the home and others who support them which shows the fees they have paid for their care. There were no noticeable hazards at the home throughout the inspection and arrangements are in place to minimise risks for people living there and the staff who support them. The home has been subject to inspections by the Fire Prevention Authority and local authority environmental health officers to make sure that the home is safe. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 6 The manager should make sure that the review and improvement of care plans is completed so that they describe in detail how staff will meet peoples needs and coordinate staffs best practice. The manager should make sure that the review of how people are supported to take risks and how safeguards and judgements are written down, is completed. This is so that there is a detailed plan in place which shows how staff have promoted independence and safety. The manager should encourage staff to make sure that public transport and taxis are used to help people who need assistance to lead more active lifestyles. The registered manager should continue to put in place improvements in the way that medication is held and administered in the home so that people get the treatment they have been prescribed and mistakes are avoided The registered manager should always make sure that there clear instructions about when medication is to be administered which can be traced back to the doctor who has prescribed it. And all medication stock should be within Page 31 of 33 2 9 3 13 4 18 5 18 Care Homes for Adults (18-65 years) 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 the use by date. 6 24 The manager should carry out the planned refurbishment / redecoration of the home including, improvements to the kitchen and laundry facilities. The manager should make sure that the repairs to the bathroom are completed. The manager should make sure that staff are well trained so that they promote the dignity and privacy of residents at all times. 7 8 24 32 Care Homes for Adults (18-65 years) Page 32 of 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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