Care Home: Southfields

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What the care home does well The home fully assesses the needs of service users and uses a dependency score, this ensures that the home is adequately staffed and that service users needs can be met. Service users have comprehensive care plans which help staff to deliver the care they need in a way which suits them, whilst promoting independence and allowing them to take responsible risks. Service users find the activities and daily routines are flexible and promote individual choice. The dependency scoring system also ensures the home is staffed adequately so that service users can participate in a range of diverse activities. Service users enjoy the food which is nutritious, well presented and with plenty of choice. Service users know how to make a complaint and felt confident that any complaint they had would be listened to and dealt with. Service users have a clean, airy home with plenty of communal space and a well equipped sensory room, as well as 2 flats to practise skills and live more independently. The staffing rota is arranged flexibly and staffing levels are adjusted according to dependency levels and activities planned. Staff receive the training and support they need to carry out their jobs, and 92% of staff have attained NVQ`s. The ethos and leadership of the home are open and transparent and service users and staff benefit from this inclusive approach. The manager and staff take quality assurance seriously and work to constantly improve the home and the experience of the service users who stay with them. What has improved since the last inspection? Many of the bedrooms have been repainted and more are scheduled when they become vacant. What the care home could do better: The medication risk assessments are very brief and do not risk assess all aspects of self medicating, though a document has been produced recently which is soon to be tried. Two infection control issues were noted, the lack of a designated hand washing sink in the laundry and the storage of clean towels in a fabric cupboard in a bathroom, though both were dealt with by the manager shortly after the inspection. The infection control audit may need to be reviewed to ensure issues are picked up and dealt with. Service users do not have individually controlled heating in the bedrooms, and some areas of the home were very hot. Key inspection report Care homes for adults (18-65 years) Name: Address: Southfields Stanhope Road Ashford Kent TN23 5RW     The quality rating for this care home is:   three star excellent 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: Justine Williams     Date: 1 5 0 2 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 26 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 26 Information about the care home Name of care home: Address: Southfields Stanhope Road Ashford Kent TN23 5RW 01233620256 01233631952 sallyfloodgate@kentgov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kent County Council care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 15. The registered person may provide the following category of service only: Care Home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning Disability (LD) maximum number of service users 15 Physical Disability (PD) maximum number of service users 1 Date of last inspection Brief description of the care home Southfields is owned by the Kent County Council and provides respite care to up to 15 adults with learning disabilities. The fees are currently £546.24 per week. People who use the service are advised in advance that this does not include entrance and admission fees for leisure activities. The home comprises a two storey purpose built detached building which includes 15 single bedrooms, a large lounge, social room, dining room, sensory room, kitchen, laundry and offices. There are 2 self contained flatlets and all rooms have TV points and an alarm call. There are suitably adapted bathrooms, toilets and showers and the home has a lift. There is a large well maintained garden which has patio areas and furniture suitable for the residents to Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 15 Brief description of the care home use. The home is located in a residential area of Ashford, within easy travelling distance of shops, health facilities, a swimming pool, churches, and a cinema complex. Staffing comprises the registered manager, team leaders, care support staff, catering and domestic staff and an administrative assistant. Southfields provides short term respite for service users with learning disabilities and physical disabilities and is also used for emergency placement. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection was carried out on 15th February 2010 between 09.45am and 02.00 pm. During that time the inspector spoke with service users, staff members, and in the absence of the registered manager, the provision manager. Feedback was given during and at the end of the inspection. At the time of this inspection 9 service users were staying at the home, 3 who had been placed as an emergency and 6 on respite. This report contains assessments made from observation, conversation and records, as well as case tracking, and with information from the Annual Quality Assurance assessment (AQAA) A tour of the premises was also undertaken and all communal areas, and the majority of bedrooms were inspected. At the last inspection the home was rated excellent and had no requirements and only one recommendation which has been addressed. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The medication risk assessments are very brief and do not risk assess all aspects of self medicating, though a document has been produced recently which is soon to be tried. Two infection control issues were noted, the lack of a designated hand washing sink in the laundry and the storage of clean towels in a fabric cupboard in a bathroom, though both were dealt with by the manager shortly after the inspection. The infection control audit may need to be reviewed to ensure issues are picked up and dealt with. Service users do not have individually controlled heating in the bedrooms, and some Care Homes for Adults (18-65 years) Page 7 of 26 areas of the home were very hot. 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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their advocates receive clear information on what the service offers and are given opportunities to visit before deciding to stay at the home for respite. Service users have their needs fully assessed prior to being offered a place at the home. Evidence: The statement of purpose and service users guides are regularly reviewed and updated and clearly state the service to be offered by the home. New service users are offered respite care only after they have been invited to visit, and decide they would like to stay and a full assessment of their needs has been carried out. The assessment is undertaken by the manager or a team leader, and is thorough, the assessment carried out by care managers is requested. For those service users who are placed at Southfields as an emergency, a full assessment is carried out by senior staff. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users individual needs and strengths are recorded in the care plans. Service users are supported to maintain their independence and are enabled to take responsible risks. Evidence: Each service users has a plan of care called a support plan. The support plans have some pictorial content, but these are being reviewed by the manager, who is trying to find a style more accessible to the service users. Support plans are checked at each period of respite to ensure they are valid and describe the service users current needs, all are signed by a member of staff to state this has been reviewed and the care plan remains valid. The support plans are detailed and provide clear information to staff about the service users needs, likes, dislikes and goals. The plans state how the individuals specialist needs are to be met, and establish specific management procedures for managing challenging behaviour. The support plans show how service users are supported to Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: make their own decisions, and how independence is facilitated. The files also contained risk assessments, these show the home encourages service users to take responsible risks. Specific risk assessments are undertaken and management strategies are developed and recorded. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users find the lifestyle at the home matches their expectations and preferences, they receive a nourishing balanced diet. Evidence: The home now employs an activity coordinator, she takes the lead in contacting service users and their advocates prior to their stay to ask about their interests and any specific activities they may like to take part in. The coordinator plans many of the trips out and activities, though care staff also arrange activities. The majority of service users at the home for respite see their stay as a holiday, and as such many take time out from their jobs or education or usual plan of activities, though this is agreed through their care managers prior to their stay. Staff support service users to access the community and they make good use of the local facilities including the theatre, cinema, local shops, swimming and leisure facilities etc. Service users are supported by staff to maintain contact with family friends and advocates whilst staying Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: at the home, and family members feel welcome at the home. The daily routines of the home are flexible and promote independence and personal choice. Service users are encouraged to have a key to their rooms depending on their capabilities, and service users are addressed by their preferred name. Service users can choose what activities they participate in and help with housekeeping tasks if they wish to or if it is agreed with them and their care manager. Service users enjoy the meals provided at the home, menus are devised according to which service users are staying at the home and there is plenty of choice. On the day of inspection service users could choose sandwiches with a variety of fillings, baked beans on toast, cheese or egg on toast. The main meal has been moved to the evening as this suits the service users and doesnt prevent them from participating in activities going on during the day. Service users with specific dietary needs are catered for and those who are nutritionally vulnerable have their needs assessed. Meal times are enjoyed by the service users. Service users who wish to prepare their own drinks, snacks or meals may use one of the kitchen in the flats, as the homes kitchen is not a domestic kitchen. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health care needs of service users are well managed. The medication policy protects service users and promotes independence but the self medicating assessment is in adequate. Evidence: The support plans clearly indicate service users preferences about how they are helped and guided, times for rising and retiring, and their preferences about the gender of staff helping them. The health care needs of service users are also well documented, and staff assist in arranging for service users to attend any health care appointments and check ups, which occur during their period of respite. Service users on respite keep their own GPs but can be registered as a temporary resident with the local GP practise if necessary. The home uses the Kent County Council medication policy, the homes practises are in line with the policy. The self medication risk assessment is inadequate, and does not include agreement from care management, GP or other health care professional, process for checking whether the service users has taken medication, responsibility for reordering, or level of help needed, for instance prompting, or help opening packaging, there is also very limited storage space in the form of a locked box fixed Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: within a drawer. The home have a document under consultation which should address the shortfalls, though storage could still be an issue. Medicines are stored according to best practise guidelines and legislation. The medication managed by the home is in line with best practice. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users views are listened to and acted upon, and service users are protected from abuse, neglect and self harm. Evidence: Southfields have received 4 complaints in the last 12 months, 3 have been resolved and the remaining one is being dealt with. Service users have a simple form they may use or they may complain verbally. Service users know how to make a complaint if they wish to, and feel confident any complaint will be acted upon. A complaint log is kept and this is used to form part of the quality assurance system, so that complaints are looked at to check for any trends. Staff receive regular training updates in adult protection and staff understand their role in reporting safeguarding issues. There are robust procedures in place for the protection of vulnerable adults. Staff are recruited only after necessary checks are made and the homes policies and practises around the management of service users money are sound. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have a comfortable and well maintained environment in which to stay. The home is clean and hygienic. Evidence: Southfields is a purpose built residential home originally for double the amount of service users, the rooms have been made larger, to accommodate service users with moving and handling needs, some bedrooms have overhead tracking for hoists. Redecoration work is being undertaken and the rooms on the ground floor are being painted as they become vacant, the rooms on the first floor have been repainted. The communal areas are decorated and maintained to a good standard. The home offers access to local transport, and amenities. There are 2 flats attached to the home for more independent service users or those practising skills such as cooking. There are 2 lounges, a dining room next to the commercial kitchen, a laundry, a well equipped sensory room, and lounge with Nintendo Wii which is very popular with service users. Some areas of the home were very hot, and the provision manager confirmed that there had been issues with the heating and the excessive heat in some areas had not been fully resolved. The radiators cannot be controlled in service users bedrooms, making it potentially uncomfortable for service users. The provision manager agreed to look into this, the inspector had a telephone conversation with the manager after Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: the inspection and she confirmed that this would be looked into. The home was clean throughout, the laundry is lacking a designated hand washing sink, the provision manager agreed to resolve this. Staff demonstrated sound infection control knowledge, regarding laundering soiled linen, hand washing and protective clothing. Clean towels are being stored in one of the bathrooms in a fabric storage cupboard. This presents an infection risk and again the Provision Manager agreed to review this practise urgently. A later telephone conversation with the manager confirmed that these issues have been dealt with. An audit of infection control is carried out regularly, but failed to identify the issues identified by the inspector. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being cared for by a stable, trained staff team, recruited safely and in sufficent numbers. Evidence: Southfields continues to benefit from low staff turnover, the service users comment that they like to see staff they know each time they stay for respite. All new staff receive a full induction and must successfully complete a period of probation. New staff also undertake the learning disability qualification, which is nationally recognised. 92 of staff have an NVQ qualification and the 2 remaining staff are expected to complete their NVQ courses in summer 2010. Southfields has an effective dependency scoring system in place to ensure the needs of the service users can be met and to ensure that diverse activities can take place. Regular staff meetings take place and these are held at varying times to enable staff to attend, for those who cannot attend the minutes are circulated to all staff. New staff are recruited using a sound recruitment policy, and are confirmed in post only after 2 satisfactory written references and the relevant police checks have been made. The staff files contained evidence of all the necessary checks and proof of identity etc. Service users are actively involved in the recruitment of staff, they meet with prospective staff as well as taking part in the interview process. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: The training programme meets Sector Skills Council targets, it includes core training in subjects such as moving and handling first aid etc for all staff. Additional more specialist training is sought and provided depending on the needs of the service users, and to promote good practise. All new staff receive a full induction and following this updates and additional training is organised. Training is monitored by using a computerised training matrix, as well as a diary, this helps staff keep training up to date. Training needs are assessed through the supervision process and appraisal. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and there are systems in place to maintain and improve standards. Health, safety and welfare is promoted and protected. Evidence: The manager has been in post for around 2 years, and registered with the Commission shortly after taking up post. She has attained the Registered Manager Award. The manager undertakes training to keep her skills up to date. The manager has worked with people with learning disabilities for many years and has managed the nearby day centre. The management approach of the home promotes an open atmosphere where staff and service users feel involved in the running of the home and feel able to affect change. There is clear leadership and an inclusive atmosphere. Southfields has robust quality assurance systems in place, surveys sent out annually are analysed by a separate team at Kent County Council, service users are aware of this and so feel able to be very honest in their feedback. Accidents, complaints and other documentation and practises such as infection control are also audited by the manager and senior staff. The home has not surveyed service users recently though service users are Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: given a how was your stay questionnaire on leaving the home. There is an annual development plan for the refurbishment and planned physical improvements though this could be expanded upon to include a development plan for all aspects of the home. There are robust policies and systems in place to ensure the health, safety and welfare of service users staff and visitors to the home, including training of staff, servicing and checks of electrical equipment etc. Risk assessments are carried out on the environment and actions are taken to minimise any risks identified. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 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. 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