Care Home: Stagenhoe Park

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What the care home does well People who live in the home receive a good quality of personal care and health care. The home provides a specialist service for people with complex neurological conditions, including multiple sclerosis and Huntington`s disease. It has Preferred Provider status with the Multiple Sclerosis Society, in recognition of the quality of understanding and care that is provided for people with multiple sclerosis. There is good relationship between the staff and the people who live in the home. The staff are aware of each person`s individual needs and preferences, and they support them to make appropriate choices and decisions about their lives in the home. The Annual Quality Assurance Assessment (AQAA) stated, "We recognise the rights of the people we are caring for to have as much control over their lives as possible given the nature of their complex care needs." Everyone who we spoke to said that they are happy in their home. One person compared Stagenhoe Park to other residential care that they had experienced, and said,"This is the best home I`ve been in. It is fun and the staff have learnt how to communicate with me." Another person told us, "The care is excellent." The home provides full facilities and equipment for the complex health needs and disabilities of the people who live there. But despite this, the atmosphere is welcoming and relaxed. All the bedrooms are personalised and show each person`s individual interests and character, and the parkland setting of the home provides scenic views from the windows. The home`s quality assurance system is based on the principle that the people who live in the home are at the heart of the service, and their views and those of their relatives are vital to inform further developments and improvements. The process includes regular audits, thorough monthly monitoring visits by the provider, and annual questionnaires for the residents. What has improved since the last inspection? The home has maintained the good standards that we found in the last inspection. The registered manager was seconded to another Sue Ryder home, and returned to the home the week before this inspection. What the care home could do better: The manager recognises the areas for development in the service, and the home`s plans for the next year include a new complaints procedure, with central electronic monitoring, and developing a `Falls Toolkit` which will link falls risk assessment to managing the risk of falls whilst mobilising or whilst in bed. We have made requirements concerning the safe storage of items that may cause a hazard to people in the home, and for secure storage of personal and confidential information. We are confident that the management in the home will address these and ensure that good practice is maintained. Key inspection report Care homes for adults (18-65 years) Name: Address: Stagenhoe Park Sue Ryder Care Centre Stagenhoe Park St Pauls Walden Hitchin Hertfordshire SG4 8BY     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: Claire Farrier     Date: 0 5 0 3 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 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) 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 33 Information about the care home Name of care home: Address: Stagenhoe Park Sue Ryder Care Centre Stagenhoe Park St Pauls Walden Hitchin Hertfordshire SG4 8BY 01438871215 01438871083 fran.short@suerydercare.org www.suerydercare.org Sue Ryder Care care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: This home may accommodate 50 people (aged 18 to 65 years and above 65 years) with physical disability who require nursing care. This home may accommodate people with physical disability caused by chronic illnesses such as Huntingtons Disease and other neurological conditions. Date of last inspection Brief description of the care home Stagenhoe Park is a large Georgian House set in 8 acres of parkland style gardens overlooking the Hertfordshire countryside. The home provides specialist nursing care for younger adults and older people with Huntingtons Disease and other neurological conditions. The home is approximately 15 minutes by car from Hitchin. There is an infrequent bus service, however the home has 2 ambulances and a mini bus. The main building is divided into two units. The majority of residents are accommodated in single rooms with access to lounges and assisted showers and bathrooms suitable for people with complex physical needs. Overhead tracking hoists are provided above each bed. There is also a conservatory, library room, smoking room and chapel in the main Care Homes for Adults (18-65 years) Page 4 of 33 50 Over 65 50 Brief description of the care home house. Two passenger lifts provide access to the upper floors. There is a covered walkway from the main house to the Rachel Bowes Lyons Unit, which is a purpose built bungalow with 16 single bedrooms with en suite facilities, an activities room, a sensory room and a physiotherapy treatment area. The home has a Statement of Purpose and Service Users Guide, which include contact details for the Commission for Social Care Inspection (CSCI), a copy of the latest inspection report is also prominently displayed in the homes reception area. Weekly fees range from £909 to £1623. Additional charges apply for personal toiletries, hairdressing, chiropody, newspapers and private dentistry. Care Homes for Adults (18-65 years) Page 5 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: 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: We spent one day at Stagenhoe Park, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to eight people who live in the home. We also talked to some of the staff and the manager and we looked around the home. We looked at some of the records kept in the home. We also looked at a sample of care plans so that we could see how people are involved in planning their own care and support. We returned to the home the following day to discuss what we saw during the inspection with the Head of Care and the Regional Development Manager. The home sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CQC before the inspection, and their assessment of what the service does in each area. The AQAA is a self-assessment that focuses on how well outcomes Care Homes for Adults (18-65 years) Page 6 of 33 are being met for people who live in the home. It also gave us some numerical information about the service. Evidence from the AQAA has been included in this report. Care Homes for Adults (18-65 years) Page 7 of 33 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 Care Homes for Adults (18-65 years) Page 8 of 33 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 9 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 10 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. Prospective residents are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each persons care needs. Evidence: The Service User Guide is available on the Sue Ryder website www.suerydercare.org. It provides information on the service that the home provides, so that people who are considering residential care can make an informed choice. The Statement of Purpose for Stagenhoe Park states, Stagenhoe offers residential care with nursing for adults living with complex neurological conditions including Huntingtons Disease, Multiple Sclerosis, Parkinsons Disease, Brain Injury and Stroke. The home has Preferred Provider status with the Multiple Sclerosis Society, in recognition of the quality of understanding and care that is provided for people with multiple sclerosis. The home also provides a specialist service, including end of life care, for people with Huntingtons Disease. All the people who we spoke to said that the staff understand and can meet their individual needs. One person compared Stagenhoe Park to other residential care that they had experienced, and said,This is Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: the best home Ive been in. It is fun and the staff have learnt how to communicate with me. Before (in other homes) I just sat in front of the TV. The Annual Quality Assurance Assessment (AQAA) stated that the Head of Care or the senior nurse on the unit carries out an assessment before people are admitted to the home, so that they have the information to show that the home can meet the persons needs. We saw four assessments. The format includes comprehensive initial assessment sheets for all aspects of care needs, and check sheets with scores to assess the persons care needs, personal needs, relationships, motivation, mental state etc., with comments to address each persons individual needs. The assessments provide comprehensive information on what each persons needs are for each aspect of their lives. But the information on how they would like staff to support them is mixed. The initial assessment sheets for one person were written in a clear and person centred style, that showed the persons wishes and preferences. For example, Likes to go to bed after lunch and will often lay in late am. Prefers to go to bed late as they can have a cigarette. A neurological care assessment completed following their admission to the home included comments such as, Experiences a lot of pain, the treatment of which is under review at present to try to find a solution which both helps (the person) but does not dull their abilities. They have a short term goal, To continue to assist (the person) in this life changing transition into long term care, helping them to maintain as much Independence as they can. But the other assessments were more task orientated, eg, Needs feeding, uses a plastic spoon. Learning disability - poor attention = frustration = swearing at staff. Needs time and attention to encourage positive involvement with others. All the staff who we spoke to said that they have good information on how to meet each persons individual needs. But both assessments and care plans (see Individual Needs and Choices) could be improved so that all are written in a clear person centred style, to match the good practice that we saw in a few cases. Care Homes for Adults (18-65 years) Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are actively involved in planning their own care and are consulted on every aspect of community life in the home. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, We recognise the rights of the people we are caring for to have as much control over their lives as possible given the nature of their complex care needs. Consultation with people who live in the home and their involvement in decision making is central to the ethos of the home. One of the people who we spoke to said that the home is very patient led and there are regular residents and relatives forums where people can express their views. The AQAA stated that several changes have been made as a result of listening to people in the home, including privacy curtains in the bedrooms to ensure additional privacy even when the door is open, a large face clock that is easy to read in the main hall, and a Residents Notice Board with information and news posted in large fonts that are easier to read. We listened to the people who use our services and asked them how they would like to be addressed collectively. The response indicated that the Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: people who use our services, especially those who have long term placements with us prefer to be called residents as they feel that Stagenhoe is their home. The organisation has a philosophy that promotes equality and diversity in the care home. The AQAA stated, As an organisation Sue Ryder Care is committed to the principles of inclusion and diversity and aims to provide care in a non-discriminatory and socially inclusive way. Our experience and expertise in neurological care puts us in an influential position to promote a positive image of disability nationally. Residents Champions link in with the organisations national lead in equality and diversity to address improvements in engagement and welfare for the residents and their families. We looked at the care plans for four of the people who we spoke to during our visit. All the care plans that we saw have good details of the care that each person needs, but the style in which they are written varies. All the care plans had parts that were written in a person centred style, that describes how in each person would like to be supported and assisted with their care, and from the persons point of view. One person has written their own pen portrait and says, I often do not ask for things -eg food/fruit thats in my room. Please could people remind me and offer things to me. Another care plan states, X likes the structure of a routine and has things done at a set time. Speech remains poor, doesnt appear to be able to use picture boards very well. Staff continue to try new ways to communicate. This care plan includes details of the persons preferred routine, and of how to communicate and understand them. But all care plans also had some parts that were written in a task orientated manner, that stated the care needed, but had no respect for the persons wishes. Some contained language that could be seen as disrespectful, or even offensive. For example, Frequently has dark and offensive smelling urine as (the person) is reluctant to drink sufficiently. Encourage healthy options as client overweight. Some inappropriate terms that may demean or infantalise the assistance that the person needs are also used. For example cot sides instead of bed rails, feeding to describe assisting to eat, and wandering to describe walking around. On the whole the care plans that we saw contain very good information so that the staff can provide the care and support that each person needs. But the use of respectful and person centred language and terminology should be encouraged and enhanced so that all care plans match the best examples that we saw. Each person has risk assessments for nutrition, pressure sores, falls and moving and handling. Individual risk assessments include the use of bed rails and smoking. There are regular reviews, and we saw evidence that care plans are updated when changes are needed. The people who we spoke to told us that they are consulted about their care plans, and they sign that they understand and agree with the care plans, risk Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: assessments and reviews. Each persons care plan file contains documentation for decision making in accordance with the Mental Capacity Act, and information on the IMCA (independent mental capacity advocate) who will support them to make a decision if needed. The process has been used a few times to support people to make decisions about whether to be admitted to hospital. On the ground floor we saw medication records left on top of the medication trolley in the dining room, with personal information accessible for anyone to see. All personal and confidential information must be stored securely. Care Homes for Adults (18-65 years) Page 15 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. The people who live in the home are supported to live full and active lifestyles. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, As far as possible we aim to ensure that all residents have the opportunity to integrate into the local community through activities programmes and encouraging visitors, entertainers and services into the centre e.g aromatherapy, musical and theatrical events. The home has a team of four activities co-ordinators, who work with the people in the home from Monday to Friday to provide a stimulating environment that as far as possible meets their interests. There is no set schedule of group activities, but throughout the day activities are organised according to need, and may include games, art and craft activities, cooking, music and one to one interactions such as hand massage and manicures. The care Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: plans have details of what each person is interested in, and the activities staff talk to each person and try to meet their needs. One person does painting by mouth, which is a skill they learnt before coming to the home. Other people could also try this pursuit if they have the capacity to learn. One person told us that they missed doing art and drawing as they had before they were disabled. The activities staff have discussed this with the person, but they are currently not interested in learning new skills for art, because they would not not be able to do the fine drawings as they used to. The care plan for another person states, X has indicated they do not wish to attend activities sessions at present. But this person told us about their interests and how they are supported to take part, including using their personal computer and playing scrabble. The home has what one member of staff described as a good crew of volunteers, who support people with activities in the home and in the community. Some of the volunteers have specific skills to support people, for instance with computer skills. Outings are arranged on a one to one basis, or in small groups of up to three residents and staff. Popular venues are shopping, cinema, theatre, garden centres with cafes, and some people ask to walk around a specific supermarket that has memories for them. A group called Music in Hospitals provides a variety of regular entertainments in the home. No one who currently lives in the home attends college or takes part in any educational or vocational pursuits, but the mangers told us that people would be supported to do this if they wish to. Some people said that the home is quiet at weekends, and the activities co-ordintaors told us people who use Sue Ryder services nationally have said that the weekends seem long. The organisation has recognised this, and the AQAA stated, What we could do better is to extend the recreational therapy offering over seven days....We are looking at our volunteer programme to develop a befriender scheme in order to provide companionship and interaction for residents especially at weekends for those who wish. The AQAA stated, We encourage families and friends to visit whenever they wish there are no restrictions on visiting times and on birthdays and special events we will host celebrations in one of our communal rooms so that families can visit together e.g wedding anniversary celebrations. Several people told us that their close family visit them regularly, and partners are able to stay overnight with them. One person told us that the best thing about living at Stagenhoe Park is the food. the chef attends residents meetings and takes peoples wishes into account when devising the menus. Menus are planned on a weekly basis, and people make their choices of what to eat at each meal for the whole week. They are able to choose something that Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: is not on the menu. This week one person asked for a jacket potato and salad instead of one main meal, and another asked for home made soup instead of sandwiches one evening. One person who we spoke to said that they cannot change their choice of meal - it is either take it or leave it. This person was in the dining room before lunch, but did not know what the menu for lunch was. The menus for the Week are on the door of the dining hall, but this is not easy for most people to see and read. A menu for each meal clearly displayed on each table or on the wall may enable people to remember what they have requested, and to look forward to and add to the enjoyment of their meal. The specialist dietary needs of people with Huntingtons disease and other neurological conditions are well managed which provides individuals with the nutrition they need for their health and wellbeing. Care Homes for Adults (18-65 years) Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are confident that they will receive a good quality of support and assistance with personal care and healthcare. Evidence: Stagenhoe Park provides specialist nursing care for people with complex neurological conditions, including Huntingtons disease and multiple sclerosis, and for people who have suffered a brain injury or stroke. The home has Preferred Provider status with the Multiple Sclerosis Society, in recognition of the quality of understanding and care that is provided for people with multiple sclerosis. The home also provides a specialist service, including end of life care, for people with Huntingtons Disease.The permanent nursing staff and many of the support workers are experienced and skilled in the needs of people with these conditions. The staff team includes a part time physiotherapist and two part time physiotherapy assistants who provide one to one therapy and manage specialist seating and wheelchair services internally. There is a good relationship with other health professionals, including GP and consultants, speech and language therapist, occupational therapist and dietician. The records of each persons health care show that their needs are recorded and Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: monitored appropriately. Each person has risk assessments that are reviewed on a monthly basis for pressure areas, nutrition, falls and moving and handling. No one in the home currently has a pressure sore, which is an indication of good proactive skin care. Everyone is weighed regularly to monitor any risk of poor nutrition. We saw one example where a person has lost weight over several months, but there was no record of any actions taken. Another person was referred to the dietician because of an increase in weight. The dietician advised a lower calorie diet, but there was no guidance on this in the care plan, and the persons weight is continuing to increase. However all the support staff who we spoke to were clear about the procedures for monitoring weight loss and said that would report any change in weight to the senior nurse. For people who need a healthy eating diet, they would encourage them to make appropriate choices and offer smaller portions. Everyone who we spoke to said that the personal care and health care that they receive meets their needs, and they are involved in decisions about their care. One person said, The care is excellent. The home has sound systems in place for the safe management of medication. We carried out a spot check of a sample of medication records. There is a good procedure for recording medication to ensure that each person receives the medication that is prescribed for them. the organisation has a system for regular audits, and the procedures ensure that any errors are recognised and rectified without delay. We received one notification concerning a missed dosage of a controlled drug, which was an error by an agency nurse. This was discovered immediately, and professional advice was sought for the welfare of the person concerned. All trained nurses complete an assessment of their competency in administering and recording medication, and long term agency nurses are also expected to do this. On the ground floor we saw medication records left on top of the medication trolley in the dining room, with personal information accessible for anyone to see. (See Individual Needs and Choices.) Care Homes for Adults (18-65 years) Page 20 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. The people who live in the home are encouraged and supported to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. Evidence: The home has a clearly written complaints procedure. The Annual Quality Assurance Assessment (AQAA) states that two complaints have been recorded since the last inspection. A new system for recording and monitoring complaints centrally through the organisations Intranet is being implemented, and training is in place for the new complaints policy, Complaints are everybodys business. A new complaints leaflet has been considered and approved by the national service user advisory group. The people who we spoke to during our visit to the home confirmed that they are able to discuss any concerns that they have, and that these are addressed. Sue Ryder Care has robust policies for dealing with allegations of abuse or neglect. All the staff have training in safeguarding vulnerable people, and those who we spoke to were aware of the whistle blowing policy and who to speak to if they have any concerns. There has been one safeguarding investigation in the last 12 months, concerning an agency member of staff. It was reported and investigated under the Hertfordshire multi agency safeguarding procedures. Actions have been taken to ensure that the agency concerned provides all the evidence needed to show that the staff that they provide are fit to work with vulnerable people. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: The manager is aware of the principles of the Mental Capacity Act and the Deprivation of Liberty Standards (DOLS), which protect people from restraints that may be in place without proper authorisation. No-one living in the home is currently subject to a deprivation of liberty authorisation, and no-one currently has their liberty deprived without an authorisation. We saw a care plan for one person for the use of groin straps on their chair, due to the risk of falls. The wording of the care plan indicates that this may be used as a restraint on their liberty, requiring an application for a DOLS assessment. The physiotherapist assesses the use of groin straps as an aid to a good sitting position. The wording used for aids of this sort needs to be clarified so that the therapeutic use, rather than use as a restraint for the persons safety, is clear. Care Homes for Adults (18-65 years) Page 22 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 home provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. Evidence: Stagenhoe Park is a large Georgian House set in 8 acres of parkland style gardens overlooking the Hertfordshire countryside. Everyone has their own room, and all rooms have easy access to assisted showers and bathrooms suitable for people with complex physical needs. All rooms are fitted with overhead tracking hoists. There is a covered walkway from the main house to the Rachel Bowes Lyons Unit, which is a purpose built bungalow with 16 single bedrooms with en suite facilities, an activities room, a sensory room and a physiotherapy treatment area. There is a smoking room in each area of the home. The bedrooms that we saw in all areas of the home have been extensively personalised to reflect the personalities of the residents. Although the presence of equipment and aids and tracking hoists was inevitably obtrusive, the size of many rooms enabled this to be minimised. The communal areas are spacious and comfortably furnished and include a library and music room with a grand piano. This, together with the outstanding views of the grounds found in many rooms provides a very pleasant and distinctive feel to the home. The atmosphere is welcoming and Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: relaxed. The home appeared to be clean and well maintained and appropriate policies and procedures are in place for the maintenance of hygiene and control of infection. Care Homes for Adults (18-65 years) Page 24 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. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, It is our aim to recruit, develop and retain staff who will be able to meet the needs of our service users and through this we recognise staff being our most important resource. However the AQAA recognises that an area for improvement is to appoint more permanent staff. The difficulties in appointing both registered nurses and support workers means that the home uses a large number of agency staff. They have reached an agreement with the agencies that they use, so that they are supplied with regular staff who know the home and the residents, and these are included in essential training in the home. The staff levels meet the needs of the people in the home. The rotas show that there are 2 or 3 registered nurses and a minimum of 4 support workers on each shift. This provides a ratio of at least 1 person providing care to 8 residents. We spoke to a selection of staff of all levels, including support staff and domestic staff. Everyone who we spoke to said that the home provides them with good training and support. The training schedule slipped during the second half of 2009 due to the training manager being on sick leave. An external company has now been employed Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: to provide mandatory training, and everyone is up to date with their training needs. Over 50 of the care staff have a qualification at NVQ level 2 or above, and new staff are expected to register for NVQ training when they complete their induction. Support is provided to all staff through individual supervision and appraisals, and regular team meetings. We looked at the staff files for three members of staff of whom two have been employed during the last year. They all contained all the required information to show that the home practices a robust recruitment procedure that ensures the person is fit to work with and protect the vulnerable people in the home. The file for a person who started to work in the home very recently did not contain references, but these were received by the home before the person was appointed. We saw evidence that NMC (Nursing and Midwifery Council) PINs (personal identification numbers) and work permits were renewed before they expired. Care Homes for Adults (18-65 years) Page 26 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. The home is well managed for the benefit of the people who live there, and their views are actively sought and acted on. Some health and safety issues have been addressed to ensure that the home provides a safe environment for the people who live there. Evidence: The ethos of the home is that it is the home of the people who live there, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. The management team communicate a clear sense of direction and leadership, and they are available to both staff and residents when they wish to speak to them. There is a commitment to equal opportunities and people have their cultural needs addressed within the care plans. The registered manager had returned to the home the week before our visit, after a period of secondment to another Sue Ryder home. This home has now closed, and several senior members of staff have transferred to Stagenhoe Park. During the managers secondment an acting manager was appointed, and it was the acting manager who completed the Annual Quality Assurance Assessment (AQAA) that Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: provided the Commission with information about the service before our visit to the home. He sent us the AQAA when we asked for it, and it was clear and gave us all the information we asked for. The homes quality assurance system is based on the same principles as their ethos, that the residents are at the heart of the service, and their views and those of their relatives are vital to inform further developments and improvements. The AQAA stated, We constantly review our service through a Quality Improvement Group and Care Centre wide Quality Improvement Plan. We carry out a monthly programme of audits, which includes monthly Regulation 26 Visits. We saw the report of the most recent Regulation 26 monitoring visit to the home. The format follows the headings and outcomes of the new CQC compliance regulations, and includes the views of residents and staff. Reg 26 visit takes a full day each month, and provides a very comprehensive quality audit of the service. We saw the report of the results of the residents survey that was carried out in January 2010. 75 of the people who completed surveys rated the home as an excellent or good place to live. 95 responded that staff make an effort to meet their individual needs, and that the care they receive is satisfactory, good or excellent. Comments included: Like a home from home. Feel safe and cared for by staff. Four people said they would like Better food. Two people mentioned changes in staff. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. The home maintains appropriate records for the health and safety of the residents and staff in the home. The Environmental Health Officer visited the home in January 2010 to inspect the kitchens, and actions have been taken to address the minor improvements that were suggested. We checked the fire safety records, and the records of water temperatures in the home. Water temperatures are tested regularly, to ensure that the temperature is maintained at a safe level for the people in the home. However, the records show that hot water in the baths and showers is tested at a mixed temperature. In order to minimise any risk of scalding, the temperature of the hot water alone should not exceed 43 degrees Centigrade. We found two health and safety concerns during our visit to the home. The door to one medication room was held open, giving easy access to an oxygen cylinder, sharp scissors and the controlled drugs register. The controlled drugs register contains personal information, and needs to be stored securely. There is a risk that people may enter the room unobserved and be at risk if they handle the scissors or the oxygen cylinder. We found spray bottles of bathroom cleaner in one unit, in unlocked cupboards in two bathrooms and in the kitchen. Later we saw the COSHH (Control of Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: Substances Hazardous to Health) risk assessments, that showed that these items do not need to be stored securely. However an unlocked cupboard in the kitchen also contained two uncovered plastic boxes containing dishwasher tablets, for which the COSHH assessment stated that they should be stored securely, and in their original packaging. This was rectified before we completed the inspection. 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 1 10 17 All personal information 05/05/2010 must be stored securely in order to protect the confidentiality and privacy of the people who live in the home. People who live in the home need to be confident that personal information about them is not accessible to people who do not need to see it. 2 42 13 All substances that may be 05/05/2010 hazardous to health must be stored securely at all times. The people who live in the home should be confident that all parts of the home are free from possible risks to their health and safety. Care Homes for Adults (18-65 years) Page 31 of 33 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 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. 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