Care Home: Station House

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What the care home does well There is accessible information for people about the home and how it is run, and families are consulted about policy changes. Each person is treated as a unique individual. There are comprehensive assessments and personal care, health, social care and sensory needs are met. People choose food and activities daily. Staff know them well and use communication aids so that people make daily decisions. They lead healthy lifestyles, try new things and progress towards goals. Staff are all qualified, keep up to date and provide consistency of care. People and staff have good relationships. The registered manager leads a person-centred approach and ensures staff have support and keep up to date in new ways of working to benefit people and respect their rights. The environment is homely, warm, clean and there are robust systems for health and safety. It is well maintained with good facilities to promote independence. There is forward planning about people`s future needs, and about recruitment and staffing so that people can have more opportunity to go out in the evening and on weekends, and to move on. What has improved since the last inspection? Staff are constantly looking for new activities and outings, which are risk assessed before they take place. People respond better to day trips, but a short holiday for two people is being planned. The home`s chemist was changed so that prescriptions did not need collection and go from the GP to the pharmacist. The manager audits medication and observes staff, and staff observe the manager. A person we had concerns about on our last visit was followed up and their access to health care improved, and best interest decisions will be made with a consultant. Health advice was used to help people gain or lose weight. Most of the home was decorated. Lounge carpets and suites replaced, and a new kitchen installed. The responsible individual took part in a safeguarding investigation by the council, which exonerated the home from any concerns. The home learned from this, new laws and from their last inspection, and have a more robust safeguarding strategy, such as their safe recruitment checks and improved staff induction policy. An independent consultant now checks quality, health and safety, and sent us a report of their findings in September 2009. An independent advocacy service met with people so that any concerns could be expressed, and plans for future service development matching needs could be explored. What the care home could do better: Written and widget information need to match for accuracy, be more concise, and an auditory version would enhance people`s understanding and retention. Terms and conditions could be more transparent about fees, and simply explain the rules and people`s responsibility to respect each other`s rights and property. Medication audit records need to reflect findings and actions taken to any errors to protect people`s health and prevent recurrence. The shelf life of medication needs to be checked so that it remains effective treatment. Restraint is rarely used but incidents need more critical review to ensure protocols and procedures were appropriately used and safeguarded people`s rights. Notifications need to be made to the Commission in accordance with current guidance. We need to work together to keep people safe. The home`s risk assessments and development plans need to take account of all applicable laws and regulators guidance. For example, about the water supply, bedroom facilities and privacy. Key inspection report Care homes for adults (18-65 years) Name: Address: Station House Station Road Admaston Telford Shropshire TF5 0AP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tina Smith     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: Station House Station Road Admaston Telford Shropshire TF5 0AP 01952242648 01952740262 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Overley Hall School Limited care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code 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) 4 Date of last inspection Brief description of the care home Station House is a detached house near the bridge in Admaston, near Wellington, local shops, a church and car parking at the front. Personal care is provided for four people with a learning disability who each have their own rooms and share a bathroom and communal toilets. Hand wash basins in rooms are disconnected. The service user guide says that fees are individually determined on the support needed, and enquiries need to be made to management. 2 1 1 1 2 0 0 8 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The service was last inspected on 21/12/08. Before our visit, the home sent us information about the home, what improved and is planned in their Annual Quality Assurance Assessment (AQAA). Their self assessment was analytical and told us what they had done to comply with previous requirements. Information from the AQAA and other sources was used when forming judgments on the quality of the service. We had surveys from everyone living in the home, assisted by staff to complete them, no relatives and two staff. We had one report of a safeguarding concern since our last inspection. The council confirmed that no abuse or neglect was found. One inspector visited the home 12:15 pm to 20:15 pm. The home did not know we were coming and there was a party going on, so we met most of the staff and a volunteer. We looked around the home, spoke with people and observed their Care Homes for Adults (18-65 years) Page 5 of 30 interaction with each other and staff. We saw their care, health, financial records and activity plans. Records were seen about: staffing and training, maintenance, complaints, safeguarding, incidents and audits. We discussed and saw policies and procedures about medication, safeguarding, mental capacity, Deprivation of Liberty Safeguards, restraint, infection control, fire safety, food hygiene and human resources. We discussed our findings with the manager, present throughout our visit. Four previous requirements were met. No requirements were made as people were well cared for, content and have a good quality of life. The manager acted upon any matters we queried. Recommendations are at the end of this report. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Written and widget information need to match for accuracy, be more concise, and an auditory version would enhance peoples understanding and retention. Terms and conditions could be more transparent about fees, and simply explain the rules and Care Homes for Adults (18-65 years) Page 7 of 30 peoples responsibility to respect each others rights and property. Medication audit records need to reflect findings and actions taken to any errors to protect peoples health and prevent recurrence. The shelf life of medication needs to be checked so that it remains effective treatment. Restraint is rarely used but incidents need more critical review to ensure protocols and procedures were appropriately used and safeguarded peoples rights. Notifications need to be made to the Commission in accordance with current guidance. We need to work together to keep people safe. The homes risk assessments and development plans need to take account of all applicable laws and regulators guidance. For example, about the water supply, bedroom facilities and privacy. 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 30 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 30 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. People and families have accessible information about the service. There were no new admissions but there is a pre-admission process and mutual decisions are made. Families and multi-disciplinary reviews confirmed that peoples needs continue to be met. Evidence: Four people living in the home are funded by four councils in the south of England. We looked at written public information and the records of two people as there were no new admissions. Pre-admission assessments were seen at our last inspection and found to be accurate and of good quality. Staff work through the service user guide with people - it is in widget pictures and symbols and can be easily read by one person. The code of conduct could describe the responsibilities of the home and individuals more concisely so that people can understand the rules for staff and themselves. The guide includes policies and procedures, which is excellent but it is too long for people to retain information. The statement of purpose has accurate information about the service and staff. People Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: with sight impairment would benefit from an audio version. Both people had terms and conditions agreed with their families. The guide says that fees are individually determined. Transparency could further improve by providing the rate fees start from and what fees include, for example whether holiday, transport and escort costs for health appointments are included. The pre-admission process is described in the guide, with a variety of ways to visit and have an assessment so that mutually agreed decisions are made about the homes suitability. Admissions are planned at the persons pace, and are reviewed after a 28 day trial period. Comprehensive assessments are kept under review by the home. Meetings are held at least annually with people, families and funding authorities and records show that their needs continue to be met. Both people continue to make good progress in their personal development. The organisation is forward looking and is planning a means of promoting growing independence. Care Homes for Adults (18-65 years) Page 11 of 30 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. People are treated as individuals and maximise independence, emotional wellbeing, personal and social development at their own pace. Their goals, interests, diverse cultures and sensory needs are met. Communication aids and advocacy assist self expression and contribute to best interest decision making. Evidence: After the last inspection the provider arranged for an independent advocacy service has met with people on at least two occasions so that they have support to express their views. The provider is starting to look at future options for more independent living. All four people have learning disabilities, autistic spectrum traits, limited communication. Social work and health assessments, and the homes assessments identify how each person is incapacitated, as they cannot make serious decisions for themselves. Each person has regular contact with a representative and interested parties so that serious best interest decisions are made together and financial interests are protected. Staff make daily decisions after consulting people. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: In May 2009 the Commission had a report with concerns about the degree of choice people had, which the council and provider disproved. In September 2009 a quality monitoring report and later the AQAA told us that records of menus and choices are kept, religious needs are catered for. The surveys we received from people say that they can usually do what they want each day, and their choices are respected, which we confirmed on our visit. In two care records we saw comprehensive assessments, person-centred plans and health plans showing that people have physical and mental stimulation. Daily records and staff handovers are used very well to monitor food intake, health and wellbeing and the manager evaluates these periodically and ensures any necessary follow up action or specialist advice if necessary. Personal allowance records are up to date and tallied, and families are provided with written statements. Financial records could be improved by code or detail matching receipts, so that spending decisions by staff can be monitored, but it appeared to match individual needs. Communication plans show that a variety of communication aids are used with people, such as photo diaries, Makaton signs and PECK guidance. One persons vocabulary and speech has improved. Two people are able to read widget and one is able to use the office computer to write in widget with support. There are male and female staff for gender appropriate support and to meet cultural and religious needs and preferences. Staffing is flexible enough to provide daily individual choice of what they do, and this is soon to improve further. Each person has aspirations and goals for their health as well as social and intellectual development. And everyone is progressing at their own pace. One room has a listening device, which we queried. This is used to monitor if one person becomes restless at night. A stairgate is put on at these times so that they have freedom of movement but are protected from falling downstairs as they have severe sight impairment. Care Homes for Adults (18-65 years) Page 13 of 30 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. Healthy lifestyles are promoted through a balanced diet and exercise, appropriate to culture, religion and nutritional plans. People have structure to their day, as well as daily choices to match their moods. There are opportunities to try new things and to take part in the running of their home. Evidence: On our visit everyone was out with staff or at Overley Hall for their morning activity and returned to the home for a surprise party for a staff member. We saw their new individual activity plans showing that people have structure to their day as well as diverse activities which they usually want to get up for. Some are earlier risers than others. On weekends they have a lie in if they want to, and time for leisure and their interests. Staffing is flexible enough to meet daily preferences and this is soon to improve further in the evenings and on weekends. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Opportunities for personal and intellectual development take place at peoples own pace. Each person has regular exercise through walks, swimming and experiences on outings such as canoeing. They help to look after their possessions or the home and some prefer to have regular jobs, such as putting out the recycling rubbish. Photo diaries celebrate their achievements and show that they have fun and individual support, and these are used along with photo menus as aids to help people make choices. During our visit people liked looking through them. Two people are having a holiday planned and others cope better with day trips. Everyone keeps in touch with their families by home visits, family visits to the home, by widget letters sent to each other and by staff assistance with phone calls. Families also have roles in peoples financial affairs. Families and people were consulted about religious practice and worship to establish preferences. Male staff assisted one person to attend a local mosque but when this distressed the person, passages of the Koran were read to them at home. We are told that another family are pleased as their son can now accompany them to temple as he copes now in new social situations. We observed an unusual day regarding meals. Party food was enjoyed by people who ate where they felt comfortable for lunch. One person was a bit overwhelmed by the celebration and joined the inspector and manager in a quiet lounge while others had a buffet in the dining room. All ate together in the dining room at tea time and one person asked the inspector to join them. Each person chose what they wanted or was provided with various cold and hot foods until staff found what they preferred. One person had a plate guard so they could eat by themselves. Portions were generous; two staff supported people and everyone ate well. We complimented good practice. In the evening people and staff watched a football game together, which they all wanted to do. Some had supper and some were using their hobby materials while watching TV. Two care records showed us that people decide their own bedtimes; night time routines and support have detailed guidance for staff. Care Homes for Adults (18-65 years) Page 15 of 30 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. Support is provided the way people want and need in best interests. People take part in their care and privacy is respected. Medication is mainly safely managed and reviewed with doctors to protect people. Health, nutrition and wellbeing are effectively monitored with specialists consulted as necessary. Evidence: People have support with personal care the way they want, and are prompted to manage as independently as they can. So most brush their teeth, have a bath or shower when they want and have help choosing clothing appropriate for the weather and help with buttons and zips. People were well groomed and dressed in age and peer appropriate clothing. One person had a period of refusing to bathe when the home sought professional advice. People have regular health checks and medication reviews. Some will not cooperate with dental and medical examinations, and on our last visit the home needed to promote a persons access to specialist health advice and a best interest decision about a potentially serious health concern. The manager discussed this with the GP and an appointment is due to take place shortly with a consultant. Eye conditions are Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: overseen by consultants. Dental care has been conducted under anesthesia after a hospital liaison nurse supported the person to understand what would happen, and the home intends to use this service again to prepare for an examination as it was successful in keeping the person calm. Nail care used to need treatment under anaesthesia, however the home have supported people well and people and staff can now do this together safely. Everyones hearing was recently tested and staff learned that hearing is fine - people selectively choose whether or not to respond to sound. Menus we saw show a healthy and nutritious diet meeting religious and cultural preferences. Nutrition plans reflect health conditions or any allergies, and have aims appropriate to individual health needs identified at multi-disciplinary and family reviews, or when necessary. Peoples weights are now stable after one person needed to gained weight, while another needed to lost weight with health advice. Personal safety is well assessed. Outings are risk assessed, and both have detailed guidelines for the use of limited restraint techniques to manage peoples fears and anxieties in a controlled and safe way when necessary. Incident reports and medication records showed that these measures are rarely used. Staff are trained and skilled in accredited techniques. Two care records had mental health and behaviour management best interest plans to control agitation and aggression, occasionally to each other without lasting injury. Health professionals helped the home draw up protocols for de-escalation and distraction techniques, and contingencies for occasional use medicines regularly reviewed together. The home checked with the pharmacist that none of the occasional use medicines were Schedule 2 drugs to determine secure storage requirements. The home use a safe monitored dose system for medication for those who have medication. All care staff were trained by a pharmacist who checked competence. Their practice is regularly observed by the manager, and they observe her, which should be recorded for annual appraisal. No one is able to self-manage medication but people take part in applying creams. Refusal to take medication is respected. If frequent, or if there is concern about health or wellbeing, doctors or specialists get involved. The manager audits medication but this may not be frequent enough to ensure health is protected. The shelf life needs to be checked. A pharmacy label obscured the use-by date which had not been queried until we raised it. Two staff check medication received into the home. There were minor carried forward and addition errors which were investigated and explained during our visit so we can confirm people had their Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: medication as doctors intended. Audits need to reflect findings and actions and the Commission needs to be informed of any errors. The manager observes staff administering medication, and staff observe her, but this should be recorded and reflected upon in annual work performance appraisals. Quality monitoring checks also check medication records. Care Homes for Adults (18-65 years) Page 18 of 30 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. Complaints and concerns are taken seriously and appropriately acted upon but records do not reflect findings, actions and any learning. Safeguarding strategy has improved but analysis of the use of restraint must be more sophisticated to promote peoples rights and safeguard wellbeing. Evidence: There is a complaints procedure in two versions. We saw the complaints log which had a summary of one complaint that was also a safeguarding concern. The home participated with a complaint investigation by the responsible individual and a safeguarding investigation by the council which exonerated the home. The complaints log needs to reflect the entire process, findings and outcomes but this was not in the log. We confirmed this with the council and were sent information agreed after our visit, but it does not reflect upon time scales and any learning. Since the last inspection the home has improved the breadth of their safeguarding strategy to keep people safe. Financial interests are protected by robust accounting systems and written statements are provided to peoples financial representatives. However the code of conduct does not currently prohibit staff from involvement in peoples financial affairs or wills. Robust recruitment checks take place before staff work in the home. There is a good sexuality policy that provides balance between human rights, mental capacity law and safeguarding. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Restraint is rarely used and is sometimes necessary from the care records we saw, to protect individuals, other people, staff or the public. Four incidents were logged but some need more critical review by the manager to ensure protocols and procedures were correctly followed, restraint was warranted and effective. There were two occasions when physical restraint was necessary. These were appropriately audited and the Commission was informed. However we were not informed about chemical restraint protocols or incidents. We discussed one incident with the manager as records showed a confrontational approach by staff led to escalation and occasional use medication was noted as having no effect. Chemical restraint was only used twice for one person since April 2009, and was not used at all for another person. Physical holds used did not cause injury and helped people gain control when panic occurred in public. Care Homes for Adults (18-65 years) Page 20 of 30 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. Station House is homely, comfortable, safe and well maintained. People have facilities and equipment they need to promote communication and independence. Facilities in bedrooms need review to promote privacy and ordinary life experience proportionate to the risks involved. There are good measures to prevent and control infection and for food safety. Evidence: The home is located at the end of a village by a stream, so there is front door security and an enclosed garden to keep people safe but allow freedom of movement. Communal rooms have been decorated and refurbished since the last inspection and were comfortable and homely. Peoples rooms are delightful - each reflect unique personalities and people chose the colour schemes. One person chose a colour that may be over-stimulating so this will be reviewed. Hand wash basins in rooms are disconnected. We were told this was discussed with social workers but there are no records about this. There is a blanket policy about no door locks in peoples bedrooms which families were consulted about. Both did not appear to be proportionate to the risk assessments and records we saw and we advised review in light of human rights, mental capacity law and peoples capacity to change and benefit from ordinary life experience - proportionate risk taking. We Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: discussed alternatives that had not been considered to improve privacy. The home is well maintained and repairs are timely. Hot water temperature checks are taken twice a day for the bath and shower. Apart from the shower they are maintained in the safe range to prevent scalds. The fire risk assessment is reviewed annually by the manager and by a consultancy firm. The fire evacuation plan is reviewed after twice yearly drills. The AQAA shows service contracts are kept up to date. There are good infection controls in place, including an influenza and swine flu plan with extra controls put into effect. One person had swine flu and was treated by the doctor and no one else has been affected. There were minor improvements possible. The manager was aware that tiles recently damaged need replacing in a bathroom. Personal toiletries are not shared but they are lined up in the shower and could be put in individual drawers in the bathroom. The home provided a legionella risk assessment after our visit but this was undertaken by a contractor in 2007. The homes risk assessment must identify the frequency of checks and any necessary monitoring and/or measures to prevent the build up of bacteria and legionella in the water supply to protect health. The manager said that Environmental Health have not visited for sometime. Sealants were replaced in the kitchen in response to their visit. We checked and found the temperatures of the fridge and freezer were in the safe range, and food is probed so that it is cooked to the right temperature for food safety. There are robust fire safety precautions and regular drills involving people and staff. Care Homes for Adults (18-65 years) Page 22 of 30 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. Staff are checked to be safe and the induction policy was improved. All staff have care qualifications and training for their roles and safe working practices. Staffing provides flexibility and consistent care and there is forward planning to improve opportunities for people. Evidence: There is a low staff turnover and people have consistent care because three bank staff are shared with Overley Hall. Staff are being recruited in advance of a worker reducing their hours. The manager is trying to recruit to match the homes development plan so that they can offer more flexibility for people to go out in the evening and on the weekend. There are up to four care staff during day shifts depending on individual activities or outings, health appointments which they plan in advance and two or sometimes three night staff. So there is flexibility in accordance with peoples needs. The manager is supernumerary. We checked two staff records and people can have confidence that there are robust and best practice three yearly police and vetting checks to make sure that staff and one volunteer are safe to work with people. Supervision of staff takes place six to eight weekly, and appraisals are annually held. The induction policy was reviewed after their last inspection. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: All staff and bank staff have care qualifications and one retired from nursing, which exceeds minimum standards. Staff have additional qualifications and training for their roles and about best practice such as de-escalation techniques to manage behaviour. Named drivers have minibus training. There are two levels of first aid training and two staff have resuscitation skills for an emergency. All care staff had accredited medication training in 2007. Staff meetings and supervision include updates about medication and its effects and new ways of working, and the homes guidance for staff is detailed. Care Homes for Adults (18-65 years) Page 24 of 30 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. A qualified and experienced registered manager keeps staff up to date and leads person centred care. Robust systems and quality monitoring ensure health and safety. The provider and manager are forward looking and have a development plan to benefit people. Evidence: The manager is registered by the Commission and has appropriate care and management qualifications. The AQAA was provided on time and showed critical self analysis and continuous improvement. There was learning since the last inspection and compliance with care regulations. The manager acted upon any matters we raised during our visit and provided additional information agreed. The manager keeps staff up to date and reviews policies and procedures, sometimes with families, but further review should consider all applicable law. Peoples rights can be further promoted and risk management needs more balance with risk taking. The home tries hard to give people information that is accessible about the running of the home, but widget versions did not always match the full policies in respect of Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: complaints and the securing of money and valuables. Care plans and activity plans could be more accessible with photos or symbols so that people know what to expect and what is planned each day of the week. The advocacy policy needs re-writing as it does not accurately reflect what is in place and what is required under mental capacity law. Systems are more robust for continuous learning, record keeping protects people and safeguarding strategy improved. The manager leads the person-centred approach of the home, and with the provider have a forward looking development plan to benefit people that is far reaching. Human resources are carefully planned to match the needs of people and the quality of opportunities. We discussed a few audits, logs and environmental improvements which could further improve for safeguards for health and peoples rights. Notifications to the Commission are good but need to have regard to current guidance with regard to medication errors and chemical restraint. Action was taken to improve quality assurance and the monitoring of health and safety by contracting with an external consultant to conduct unannounced checks on behalf of the responsible individual. Families are surveyed and results published. This is good practice. We complimented management and staff on our visit. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 5 14 19 Terms and conditions would be more transparent if a starting fee range, what is included and excluded are clear. Records need to evidence that a seven day holiday is provided or the equivalent in outings. Review of chemical restraint incidents needs to be timely and thorough to safeguard peoples rights, especially if occasional use medicine was not effective. Management need to make sure it was necessary, protocols and procedures were followed to avoid confrontation and abuse. The shelf life of medication needs to be checked regularly to ensure it remains effective treatment in accordance with the manufacturer use-by date or pharmacist advice. The summary complaints log needs to reflect investigation process, findings and outcomes to evidence the promotion of rights and complainant satisfaction. The staff Code of Conduct of staff needs to exclude staff involvement in peoples financial affairs or benefitting from wills, and staff should be familiar with this. 4 20 5 22 6 23 Care Homes for Adults (18-65 years) Page 28 of 30 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 7 26 The development plan should review facilities for peoples privacy in rooms and access to wash-hand basins so that risk taking and risk management are proportionate and balanced and the environment provides ordinary life experience. The advocacy policy needs review so that people have access to independent advocacy in accordance with the Mental Capacity Act to express their views and make serious decisions. All versions of the service user guide, statement of purpose, policies and procedures need to match for accuracy. If more concise and on CD, people may retain it. Care plans and activity plans would be more accessible with photos or symbols so that people know what to expect and what is planned each day of the week, such as bathing, their household job, stimulation and outings. The homes risk assessment should indicate the frequency and nature of checks about the homes water supply, and measures to prevent the build up of bacteria and legionella to protect health. Shower temperatures should be maintained within the Health and Safety Executive safe range, not exceeding 41 degrees C. 8 40 9 40 10 41 11 42 12 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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