Care Home: St Johns Cottage

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What the care home does well The home provides individualised person centred support so that those people that can move into a supported living environment are encouraged and will be supported to do so. Residents are continually consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. They are fully involved in decisions about the areas such as staff selection, the day-to-day life of the home, and its future development. Residents benefit from living in a home that is run by a competent and experienced registered manager and their rights and best interests are safeguarded. What has improved since the last inspection? Since the last inspection the home has purchased a more user friendly microwave oven for residents and replaced carpets on the stairs and landing that was of the residents choice. Paper towel holders have been fitted in all handwash areas to aid infection control. The home has arranged input from a self advocacy group for two residents to assist them in their decision making. Risk assessed healthcare plans have been introduced that enable some residents to attend healthcare appointments independently with a proforma that healthcare professionals complete for the residents records. What the care home could do better: There are no requirements arising from this inspection and we are of the opinion that the service continues to provide excellent quality outcomes for people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: St Johns Cottage Hospital Road Sevenoaks Kent TN13 3PH     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: Paul Stibbons     Date: 0 4 0 8 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 27 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 27 Information about the care home Name of care home: Address: St Johns Cottage Hospital Road Sevenoaks Kent TN13 3PH 01732457800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.selfunlimited.co.uk Self Unlimited care home 8 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 8. The registered person may provide the following category/ies 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 categories: Learning disability (LD). Date of last inspection Brief description of the care home St Johns cottage occupies detached premises which were formerly 3 cottages which have been sympathetically converted to provide accommodation for 8 people with a learning disability. The accommodation is arranged on 2 floors, there is no passenger lift. One bedroom is on the ground floor. The registered manager is responsible for the day to day running of the home. Full time and part time care staff are employed who work a rota which includes one member of staff on sleep in duty at night. The home is located within walking distance of shops and other amenities. The town centre is also within walking distance or a short bus ride away. There is a small garden to the rear of the property. Fees range from 502 to 516 pounds per week. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on the 24th September 2006. This unannounced inspection was conducted over a period of 4 hours from 1300 to 1700 on the 4th August 2009. A completed AQAA (Annual Quality Assurance Assessment) was submitted to the commission when we asked for it and it contained excellent information supported by a variety of evidence. The Registered manager was present during the inspection and all residents were seen before the conclusion of the visit as were a number of staff. Discussions were held with those present and a variety of documents and records that included Statement of purpose, Service user guide, care plans, health action plans, risk assessments, activity records, recruitment and training records, medication records and health and safety records were examined. Care Homes for Adults (18-65 years) Page 5 of 27 The interactions between staff, management and residents were observed and noted. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 27 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 8 of 27 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. Prospective residents have sufficient information on which to make an informed decision as to whether the home can meet their needs. A trial period and full assessment of needs is conducted before a permanent placement and written contract of terms and conditions is offered to prospective residents. Evidence: There have been no recent admissions to the home but three care plans viewed evidence that significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make and there is a high value on responding to individual needs for information, reassurance and support. The home has developed a comprehensive statement of purpose and service users Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: guide, which is very specific to the resident group and in a suitable format for the individual giving all the information about the home that prospective residents would want to know. All new residents receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The service focuses on achieving positive outcomes for people and this includes an independent lifestyle that may eventually lead to supported living within the community. All residents receive a contract to which they have agreed. It gives clear information about fees and extra charges which is reviewed and kept up to date. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have an individual plan of care that sets out how their health, personal and social care needs will be fully met. People living in the home are protected by the homes policies and procedures for dealing with medication. People living in the home are treated with respect and their right to privacy is upheld. Evidence: We looked at two care plans because we wanted to know whether residents personal and health care needs are being met and that people using the service make their own informed decisions and have the right to take risks in their daily lives. The care plans are developed with the person using the service and is based on a full and up to date holistic assessment. The plans are person centred and focus on the individuals strengths and personal preferences, for example, choice of carer gender Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: for personal care and bedtimes. The essential lifestyle plan includes a range of information that is important to the individual such as who and what is important to them (circle of support), how they keep safe, their goals and aspirations, their skills and abilities, and how they make choices in their life. A Listen to me book ensures staff focus on what is important to individuals. The care plans also include a details of health care needs for each resident, evidence was seen of support in attending health care appointments. The care plans include comprehensive risk assessments which are regularly reviewed. The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. Residents are continually consulted on how the service runs and are able to influence key decisions in the home whatever their communication style. They are fully involved in decisions about the home and in areas such as staff selection, the day-to-day life of the home, and its future development. The privacy of people living in the home is safeguarded through a confidentiality policy that staff and other health care professionals are required to adhere to. Care Homes for Adults (18-65 years) Page 12 of 27 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. People living in the home have a range of opportunities that will meet their social, leisure and educational needs and their own personal development. People living in the home are supported in maintaining appropriate relationships with friends and family. People living in the home enjoy a healthy and varied diet that is of their choosing. Evidence: We wanted to know if people living in the home were supported to lead a lifestyle according to their individual preferences. We looked at the care plans and activity records of three residents and it was evident that central to the homes aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life in both the home and the community in a way that is directed by the person using Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: the service. Each individual has a home day where they develop their independent living skills and take responsibility for the cleaning of their own room and to do their laundry and ironing. Residents plan their own weekly food menu and are supported by staff to make varied and healthy choices. Some residents do small amounts of shopping independently. Menus viewed indicated a balanced and nutritious diet. The company has a day service based at their Edenbridge site. There are a range of activities that residents can participate in whilst there, including, craft, music, learning office skills, horticulture centre. There are also opportunities to work in the kitchen and bistro. The AQAA states that all residents are doing either paid or voluntary work in the community between 1 and 5 days and two residents spoken with confirmed this. One resident has started a 12 week course to learn all aspects of working in a cafe environment with the opportunity to achieve certificates in First aid, Food hygiene and Health and safety. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive personal support in the manner they prefer and require and their physical and emotional needs are met. People living in the home are protected by the homes policies and procedures for dealing with medication. Evidence: We wanted to see if peoples physical and emotional health needs were being met safely and in a manner acceptable to them. We looked at three Health action plans and the homes procedures for dealing with medication. The records viewed indicated that staff and management are highly aware that the way in which support is given is a key issue for people living in the home and individual Health action plans clearly record peoples personal and health care needs and detail how they will be delivered. Residents are encouraged and supported to manage their own health care including visual, hearing, oral and GP appointments. They have the opportunity to choose their own GP and have access to all NHS health care facilities in the local community. There is evidence that regular appointments are seen as important and there are records of Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: attendances to GP and other health care professionals. The home has developed efficient medication policy, procedure and practice guidance. Staff all have access to this written information and understand their role and responsibilities. We examined the procedures for managing medication and the storage and administration is in accordance with current guidelines and legislation. Medication records are seen as key to the efficient management of health care matters and the home consistently keeps them up to date. Care Homes for Adults (18-65 years) Page 16 of 27 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 living in the home can be confident that their views will be listened to and acted on and they are protected from abuse and neglect. Evidence: Observations of interactions between staff and residents indicated that the home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The service has a clear pictorial complaints procedure that is clearly written and easy to understand. Two residents spoken with were quite clear that they would have no problem with discussing any concerns they may have with staff members. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Discussions with staff members on duty demonstrated that they know when incidents need external input and who to refer the incident to. Records viewed evidenced that the training of staff in safeguarding is regularly arranged by the Home. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Residents are protected from financial abuse by records that are transparent and regularly monitored by the homes management and provider visits. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, safe and comfortable environment with sufficient personal and communal space to meet their needs. Evidence: We wanted to see the environment in which people who use the service live in and as to whether the facilities promoted their independence. The AQAA states that residents are encouraged to see the home as their own. Observation showed that it is a very well maintained, attractive home and that being situated near to the town centre has very good access to community facilities and services. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The kitchen and laundry are designed to enable and promote the involvement of people in domestic tasks and as part of developing or maintaining independence. Three bedrooms viewed promoted high levels of privacy and have locks and the AQAA Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: states that all residents have a key to their own room. The bedrooms viewed had a number of personal possessions on display that reflected family, hobbies and interests. The AQAA states that there is a delegated member of staff who checks water temperatures, electrical appliances and all health and safety matters and all maintenance issues were seen to be recorded and actioned. The home is well lit, clean and tidy and smells fresh. There is good outdoor space where residents have a seating area and a vegetable patch. Care Homes for Adults (18-65 years) Page 20 of 27 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. People living in the home are supported by a competent and qualified staff team in sufficient numbers to meet their needs. People living in the home are protected by the services robust recruitment procedures for new employees. Residents individual and joint needs are met by an appropriately trained and supervised staff team. Evidence: We looked at three personnel files to see how the home selected employees to support people living in the home. The service has a highly developed recruitment procedure that has the needs of people who use the service at its core and the recruitment of good quality carers is seen as integral to the delivery of an excellent service. Personnel files contained evidence of applications, satisfactory references, interview notes and the required CRB/POVA checks for the safety of people living in the home. Training records were viewed and they evidence that the service ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for residents. The service uses external providers to deliver this Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: training if they have not got the appropriate skills within the organisation and over 80 of staff members have achieved an NVQ qualification in care. The AQAA states that all members of staff have achieved the Learning Disability Award framework qualification. The content of the induction and probationary periods are seen to be very robust, detailed and service specific. Induction training exceeds Skills for Care requirements and includes person centred planning and thinking. Evidence was seen that staff meetings and supervision sessions are regular and staff said they find them helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Care Homes for Adults (18-65 years) Page 22 of 27 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. Residents benefit from living in a home that is run by a competent and experienced manager and where their rights and best interests are safeguarded. Residents benefit from living in a home where their views underpin all self-monitoring and development of the home and their health, safety and welfare is promoted and protected. Evidence: The home is led by a creative and experienced Registered manager who ensures working practices provide excellent outcomes for service users. The registration certificate for the service is displayed and correct in its detail. The Registered manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities and they are working to continuously improve services. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: There is a focus on person centred thinking, with residents shaping service delivery and a strong ethos of being open and transparent in all areas of running of the home. The Registered manager leads and supports a stable staff team who have been recruited and trained to a high standard. The AQAA was returned to the commission when we asked for it and contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The service has sound policies and procedures that are reviewed and updated in line with current thinking and practice. The home works to a clear health and safety policy and all staff are fully aware of the policy and are trained to put theory into practice. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home conducts annual surveys of residents, family and friends, key professionals and staff, the last surveys received positive responses. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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