Care Home: Station Road

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What the care home does well People have their needs thoroughly assessed before they move into the home to ensure that the home is right for them. The individual plan of care for one of the people who had lived at the home for several weeks was very comprehensive and included a lot of detail about the person’s preferences. Staff were observed supporting people in a caring and sensitive manner.Station RoadDS0000072720.V375981.R01.S.docVersion 5.2Staff told us that, “People get great food and are looked after really well.” Bedrooms seen had been made personal with people being able to chose their colour schemes and add their own pictures, ornaments and possessions. All of the bedrooms in the extension are accessible for people who use wheelchairs with track hoists fitted and en suite wet rooms What has improved since the last inspection? This is the first time that this home has been inspected. What the care home could do better: Risk assessments should be reviewed and records updated to make sure that staff have the relevant information to keep people safe without restricting their independence and choice. The home must ensure that where someone has been identified as being at risk of developing pressure sores they have a detailed assessment and care plan detailing their pressure area care. The home needs to ensure that when tablets are received details are recorded on the medication administration record so that all medication can be clearly accounted for. Key inspection report CARE HOME ADULTS 18-65 Station Road 121 Station Road Burton Latimer Kettering Northamptonshire NN15 5PA Lead Inspector Catherine Perrins Key Unannounced Inspection 11th May 2009 09:30 Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 2 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 Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Station Road Address 121 Station Road Burton Latimer Kettering Northamptonshire NN15 5PA 01206 224100 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.concensusupport.com Consensus Support Services Ltd Mrs F Oluwatoyin Ogefere Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Physical Disability - Code PD The maximum number of service users who can be accommodated is 11 New Service – registered 24th December 2008. 2. Date of last inspection Brief Description of the Service: 121 Station Road provides accommodation with nursing care for up to eleven people with learning disabilities. The property comprises of a detached house with a large extension at the rear. It has been refurbished when it was purchased by the registered provider. The original house has been converted into a one bedroom ground floor flat and a two bedroom first floor flat. The first floor flat is only accessible by stairs so would not be accessible to someone who used a wheelchair. The rest of the property comprises of eight bedrooms plus communal areas, all of which are accessible for people who use wheelchairs having wide door ways, track hoists fitted to the ceilings and en suite wet rooms. Fees for the home are individually assessed and vary according to level of need. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection which means that we focussed on the ‘key’ national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. 121 Station Road is a new service and was registered with CQC 24th December 2008. As part of the preparation for this inspection a period of two hours was spent reviewing the information that CQC has received about this service. This included looking at the Annual Quality Assurance Assessment (AQAA) that the home sent us detailing their assessment of the service they provide. The inspection visit lasted five and a half hours during the morning and afternoon of a weekday. During the inspection three people were ‘case tracked’. This involves looking in detail at all aspects of their care and experiences at the home, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with learning disabilities are not always able to tell us about their experiences we used observations of people’s state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The Registered Manager was present for part of the inspection. What the service does well: People have their needs thoroughly assessed before they move into the home to ensure that the home is right for them. The individual plan of care for one of the people who had lived at the home for several weeks was very comprehensive and included a lot of detail about the person’s preferences. Staff were observed supporting people in a caring and sensitive manner. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 6 Staff told us that, “People get great food and are looked after really well.” Bedrooms seen had been made personal with people being able to chose their colour schemes and add their own pictures, ornaments and possessions. All of the bedrooms in the extension are accessible for people who use wheelchairs with track hoists fitted and en suite wet rooms What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 People using the 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’s robust admissions procedure ensures that people’s needs can be fully meet. EVIDENCE: People have their needs thoroughly assessed before they move into the home to ensure that the home is right for them. This is important because the people who live at 121 Station Road have some complex support needs. Records show that an action plan is put together for each person to ensure that the home carry out all of the necessary preparations before someone moves in. The home has a comprehensive statement of purpose and service user guide to give people information about the home and the service offered. The service user guide contains pictures and photographs to make the information easier for people with learning disabilities to understand. Staff told us that “People have settled in well.” Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People using the 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 have their needs met and their aspirations respected but records do not consistently contain all of the information that staff need to support people in the right way. EVIDENCE: Each person who lives at 121 Station Road has an individual plan of care. One of the people that we case tracked had lived at the home for several weeks. The individual plan of care for this person was very comprehensive and covered all aspects of their life including their physical, emotional, spiritual and cultural needs. Much attention had been given as to how this person liked to be cared for with details such as the type of soap and bath oil they liked to use, how they preferred to be helped to eat and details of their morning and Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 10 evening routines. The individual plan of care for this person also contained details of how staff should support the person to communicate and to make choices. It is particularly important that staff have this information as the people who live at 121 Station Road at the time of inspection are not able to communicate verbally and due to their high levels of support needs they can find it difficult to make their preferences and choices known. The individual plan of care for another person who had moved in to the home more recently was not as comprehensive and did not give staff all of the information that they need to support and care for the person in the right way. The registered manager explained that the individual plan of care for this person was still being developed from the information and assessments that the home had compiled about that person’s needs and preferences. Records show that any risks to the people who live at the home or to the staff who support them are assessed to ensure that any unnecessary risks are avoided. Risk assessments for one person showed that the risk to them in certain areas of their life was so high that it required assessment by a group manager within four hours. There was no evidence of any assessment by a group manager being undertaken. The registered manager explained that a high risk had been assumed when the person first moved in and that this had since been reassessed but the records not updated. It is important that risk assessments are reviewed and records updated to make sure that staff have the relevant information to keep people safe without restricting their independence and choice. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,14,15,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at 121 Station Road are supported to develop their quality of life. EVIDENCE: On the day of inspection the people who live at 121 Station Road spent the morning at Brixworth Country Park. The home has two minibuses which can accommodate people in their wheelchairs to enable everyone to go out to activities and visits as they wish to. Individual plans of care seen contained details of people’s interests and hobbies. The registered manager explained that the home was in the process Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 12 of developing activity plans for people to ensure that they are able to pursue activities and leisure interests of their choice. Staff told us that people enjoy going to the pub at the weekends as well as going bowling and to music sessions. Menus seen appeared to be varied and contained fresh fruit and vegetables. The support staff cook the meals. The registered manager stated that people were able to chose something different if they did not like what was on the menu. Staff were observed at meal time supporting people to eat. Records show that one person has clear guidance from a speech and language therapist that detailed how they should be supported to eat and drink. Staff were observed following this guidance and offering support in a caring and sensitive manner. Staff told us that, “People get great food and are looked after really well.” Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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 generally have their health and personal care needs well met. EVIDENCE: The people who live at 121Station Road have some specific healthcare needs such as PEG feeding (a tube inserted through the abdominal wall into the stomach which is used to give food and drink) and postural drainage (positioning someone to allow secretions to drain from their lungs.). Individual plans of care generally contained some good information about what staff needed to do to meet people’s needs in these areas. The home does, however, need to ensure that where someone has been identified as being at risk of developing pressure sores that they have a detailed assessment and care plan detailing their pressure area care. Where it Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 14 is identified that someone needs assistance to change position on a regular basis records should be kept to show that this is happening as required. Records show that people’s health needs are monitored by the nursing staff who carry out checks such as blood pressure, pulse and oxygen levels as required. The administration of medication appeared to be well managed with all entries on the medication administration record being signed. Each person who lives at the home has a medication profile which details all of the medication that they take. The registered manager explained that the home is in the process of adding people’s photographs to their profiles. The home needs to ensure that when tablets are received details are recorded on the medication administration record so that all medication can be clearly accounted for. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the 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 protected by the home’s policies, procedures and practices. EVIDENCE: The home has a complaints procedure which details what someone should do if they wish to complain about the home. The home has received three complaints since it was registered. Records show that these were investigated under the home’s complaints procedure and resolved to the satisfaction of those involved. The home’s complaints procedure was viewed and contained good information about how people should raise any concerns that they may have. The procedure needs to include the timescale within which people should expect a response to any concern that they raise. A version of the complaints policy is available in an easy read format, containing pictures and photographs to make it easier for people with learning disabilities to understand the information. Staff spoken to knew how to raise any concerns that they may have and had received training on how to keep people safe from harm. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People using the 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 enjoy a clean, comfortable and well maintained home which is able to meet their physical needs.. EVIDENCE: 121 Station Road has all been recently refurbished when it was purchased by the registered provider. The property comprises of a detached house with a large extension at the rear. The original house has been converted into a one bedroom ground floor flat and a two bedroom first floor flat. These were not occupied at the time of inspection. The registered manager explained that they were going to be made available to people who wanted a degree of independence but needed nursing care support. The first floor flat is only Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 17 accessible by stairs so would not be accessible to someone who used a wheelchair. The windows in the first floor flat did not have any opening restrictors fitted which could put people at risk of falling out of the window. The registered manager explained that restrictors were to be fitted before anyone moved into the flat. The main part of the home comprises of the extension to the original property. Communal areas consist of a lounge with a separate dining area, a kitchen and a further small lounge. The registered manager explained that the home were considering making the small lounge into a sensory room. There is also a large communal bathroom with an accessible bath. There has been some attempts to make the communal areas homely with some pictures and plants. Staff explained that more would be done to make the home more personal and to support the people who live there to add décor and effects of their choice. Bedrooms seen had been made personal with people being able to chose their colour schemes and add their own pictures, ornaments and possessions. All of the bedrooms in the extension are accessible for people who use wheelchairs with track hoists fitted and en suite wet rooms. The property has an enclosed rear garden which is currently in need of some maintenance. The registered manager explained that a sensory garden and a patio area were planned. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People using the 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 supported by a competent and well trained staff team who have a good understanding of their needs. EVIDENCE: Staff recruitment appears to be well managed with all the necessary prerecruitment checks being completed to ensure that staff are suitable to work with people with learning disabilities. The majority of staff were employed before anyone moved into the home. Staff explained that as part of their induction they worked in other homes owned by the provider shadowing experienced staff members. Staff showed a good understanding of people’s needs and how to support them in the right way. Staff told us that there were generally adequate numbers of Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 19 staff to meet people’s needs saying that “Initially we had a lot of time to read care plans. Now more people moving in we are busier.” Records show that staff receive training such as fire safety, moving and handling, safeguarding adults, first aid, infection control, food hygiene, customer service, medication and health and safety. This helps to ensure that staff do there job in the right way. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager, deputy manager and senior support workers are all registered nurses. The registered manager explained that she was in the process of sending out satisfaction surveys for the people who live at the home. She told us that she was arranging for people’s relatives to help them to complete these. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 21 Records show that safety checks such as fire checks, servicing of hoists and checks on the water had all been completed. Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 x 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 23 Station Road DS0000072720.V375981.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13 (4) Requirement Risk assessments should be reviewed and records updated to make sure that staff have the relevant information to keep people safe without restricting their independence and choice. Timescale for action 11/07/09 2 YA19 17 (1) (a) The home must ensure that 11/07/09 where someone has been identified as being at risk of developing pressure sores they have a detailed assessment and care plan detailing their pressure area care. The home needs to ensure that when tablets are received details are recorded on the medication administration record so that all medication can be clearly accounted for. 11/07/09 3 YA20 13 (2) Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Station Road DS0000072720.V375981.R01.S.doc Version 5.2 Page 25 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne Tyne and Wear NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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