Care Home: Stubblefields House

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What the care home does well People are given a good, full and detailed assessment of their needs before they move into the home and they are informed in writing whether or not those needs can be met. They receive good information on the service they can expect and have good contracts of residence once they have moved in. People have appropriate plans of care in place to enable staff to meet their needs, though they could be updated to the person centred approach. People are included in decision making and are enabled to take reduced risks to realise their potential and meet their needs. People receive very good support in taking part in appropriate activities and pastimes in the home and in the community and in making and enjoying appropriate relationships. People are well respected, can exercise their rights if they wish, and benefit from good nutritious meals. People receive the personal care and support they need, have satisfactory health care needs monitored, though health action plans are needed to reflect and meet current health needs more effectively, and they benefit from robust and safe systems for handling medication. People have good systems in place to complain or make representations, and they are kept fully informed. There are good records maintained and staff understand how to pass on complaint information. There are also good systems in place to protect people from abuse and to pass on referrals to the appropriate authorities on safeguarding. People live in a good, homely environment that is clean, comfortable and safe. Some upgrading of decoration and furnishings is now beginning to be needed. People benefit from sufficient numbers of staff on duty at all times to meet their needs, from well recruited, qualified and trained staff, that are adequately supervised. People benefit from an experienced and trained manager in post, that uses a QA system to determine the service performance. The home is well maintained and safe working practices prevail, and these are evidenced in certificates and monitoring checks on safety that are well recorded. What has improved since the last inspection? There are now risk assessments on hot water outlets and on radiators. There are now control buttons on the two showers to prevent them being too hot for people. What the care home could do better: The service could make sure there is a person centred assessment format to follow, including details in standard 2.3, in the event someone privately paying for their care wishes to move into the home, so everyone is confident their care and health care support needs are assessed and met. The service could make sure contracts of residence are reviewed and updated with people and families to reflect current situations of people and the service, so people have their residency protected. The service could make sure people have person centred care plans and risk assessments that follow a recognised format and template, so their needs are recorded using current trends in good practice and so people are confident their needs are being well met. The service could make sure all risk assessments are completed using a recognised risk tool, to determine the frequency and likelihood of risk in order to decide upon how risk will be reduced. Also so people know the risks they may take are reduced where possible. The service could implement health action plans to reflect and meet people`s current health care needs more effectively and so people know their health needs are being well met. The service could consider some upgrading of decoration and furnishings so that people have an improved environment to live in. The service could make sure the provider/manager is aware of and practices the current trends in recording and reporting the caring and supporting of people with a learning disability, so they are confident their needs are being well met. The service could make sure there is a legionella water test carried out on the hot water storage system so people know they are protected from the risk of harm from disease. Key inspection report Care homes for adults (18-65 years) Name: Address: Stubblefields House Pinfold Lane Bridlington East Yorkshire YO16 6XP     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: Janet Lamb     Date: 1 6 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Stubblefields House Pinfold Lane Bridlington East Yorkshire YO16 6XP 01262606036 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: juliedruce@btinternet.com Mrs Julie Druce care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 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 - Code LD. Date of last inspection Brief description of the care home Stubblefields care home is registered to provide care, support and acommodation for a maximum of eight people with a learning disability. This figure has increased since the last key inspection three years ago. The home now has eight single bedrooms all located on the ground floor. The home has one lounge/dining room, a kitchen and two bathrooms. There are also two showers available to people in en-suites. Patio doors lead from the lounge into a large secure garden where geese, dogs and cats live, providing a therapeutic activity. The home is situated at the end of a long residential street on the outskirts of Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 8 Brief description of the care home Bridlington. The town provides people with ample opportunity to access local amenities. There is a home mini bus to provide transport into town and beyond. The current fee is £372.50 per person per week. Information about the service can be obtained on request from the manager in the form of a statement of purpose and a service user guide. Care Homes for Adults (18-65 years) Page 5 of 32 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 Key Inspection of Stubblefields has taken place over a period of time and involved sending a request to complete an annual quality assurance assessment (AQAA) in November 2009, containing information about people who use the service and support workers and details of the homes policies, procedures and practices. The Commission received the requested information at the end of December 2009 and after the site visit had taken place, though the home had tried to send it on 15 December. Also because the key inspection was brought forward from January to December survey questionnaires could not be sent out in time. Information obtained from notifications received, from the previous report and from information already known from having had contact with the home since the last key inspection was used to suggest what it must be like living there. On 08 December 2009, earlier than scheduled, Janet Lamb made a site visit to the Care Homes for Adults (18-65 years) Page 6 of 32 home to test these suggestions and to interview people, support workers, visitors and the home manager if available. Unfortunately the inspection could not go ahead and so a second date was arranged, 16 December 2009 when the actual site visit took place. It was then that some documents were viewed with permission from those people they concerned and some records were also looked at. The communal areas of the home were viewed along with two bedrooms. There were two people who use the service interviewed, the manager was interviewed and one staff was spoken with during the site visit to seek information. No relatives were spoken with. What was said was checked against the information already known because of previous information gathering and contact with the home. Judgements were made using the information and some of the evidence used at the last inspection to say what it is like living in the home. This report shows those findings and judgements. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The service could make sure there is a person centred assessment format to follow, including details in standard 2.3, in the event someone privately paying for their care wishes to move into the home, so everyone is confident their care and health care support needs are assessed and met. The service could make sure contracts of residence are reviewed and updated with people and families to reflect current situations of people and the service, so people Care Homes for Adults (18-65 years) Page 8 of 32 have their residency protected. The service could make sure people have person centred care plans and risk assessments that follow a recognised format and template, so their needs are recorded using current trends in good practice and so people are confident their needs are being well met. The service could make sure all risk assessments are completed using a recognised risk tool, to determine the frequency and likelihood of risk in order to decide upon how risk will be reduced. Also so people know the risks they may take are reduced where possible. The service could implement health action plans to reflect and meet peoples current health care needs more effectively and so people know their health needs are being well met. The service could consider some upgrading of decoration and furnishings so that people have an improved environment to live in. The service could make sure the provider/manager is aware of and practices the current trends in recording and reporting the caring and supporting of people with a learning disability, so they are confident their needs are being well met. The service could make sure there is a legionella water test carried out on the hot water storage system so people know they are protected from the risk of harm from disease. 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 9 of 32 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 32 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. People are given a good, full and detailed assessment of their needs before they move into the home and they are informed in writing whether or not those needs can be met. They receive good information on the service they can expect and have good contracts of residence once they have moved in. Evidence: Discussion with the provider/manager, one staff and two people in the home, and viewing of some case files and documents with peoples permission shows the systems in use for assessing needs and declaring they can or cannot be met are still appropriate, but could be improved upon if the home produces its own assessment format for anyone paying privately. Stubblefields House only uses the placing local authority community care assessment documents or the local health authority assessment forms as its basis for producing a care plan for providing a service of care and support to people with a learning disability. These forms are kept in peoples case files and were seen for two people. People receive written confrmation their assessed needs can or cannot be met by the Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: home and copies of this were seen in files. Two people spoken with on the day of the site visit say they remember having had all their details assessed and were very much part of the process. They also say they continue to be included in decisions and sign documents, mainly their set personal goals, in agreement. People are happy to make their own decisions. The manager needs to make sure there is a thorough assessment of a persons needs format to follow, which is person centred and includes all details listed in standard 2.3 in the event someone comes to live at Stubblefields as a privately paying user of the service. It is acknowledged there has been no new admission to the home in many years because of the consistency people experience in their lives, but it is not unreasonable to expect that a new admission may take place and the manager needs to be prepared. This is a recommendation of this report. The homes statement of purpose, service user guide and contract of residence were not assessed during this inspection, but they were briefly discussed with the manager who says they are up to date and still relevant. Contracts seen for two people show they were reviewed and updated for the year 2004 to 2005. Perhaps they are due for review again and need to reflect the current positions of people and the service. Standards 1 and 5 were met at the last inspection and continue to be so. Care Homes for Adults (18-65 years) Page 12 of 32 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 have appropriate plans of care in place to enable staff to meet their needs, though they could be updated to the person centred approach. People are included in decision making and are enabled to take reduced risks to realise their potential and meet their needs. Evidence: Discussion with the manager, one staff and people living in the home and viewing of case files and records with permission shows individual needs and choices are recorded in care plans, that risks are a feature of life but reduced where possible and that people have every opportunity to make their own decisions. Care plans and risk assessments are in place and have been for some years so they do not follow the person centred approach that is expected of todays format. However, care plans follow the form of strengths, needs, goals and an action plan, and do include information on personal goals that are linked to personal risk assessments and both goals and risks are reviewed and recorded in line with placing local authority Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: requirements. Care plans could be improved and brought up to date if they were changed to the person centred style and approach and if they were to follow a more standardised format. At the moment they take the form of each need and attached risk being recorded on a blank piece of paper. They could be recorded on a person centred care plan template. The manager is advised to contact the East Riding of Yorkshire Council to seek training on person centred care and to bring herself up to date with the current trends in care services for people with a learning disability, in order to modernise the services recording systems and accountability. Care plans do cover areas such as social life, independence and daily living, contact with significant people, emotional wellbeing, personal care, travelling independently, kitchen skills and tasks, and pressure relief. They also include controlling of specific conditions, mobility and transferring, personal hygiene, use of wheelchair, use of hoist, food intake and special diets and safety while alone in bedroom. Health care needs are also recorded and a basic action plan is in place for each area. Risk assessment documents link in with many of these and cover safety in and out of the home. Risk assessments seen included those on managing personal care and hygiene, travelling independently, living skills, specific conditions, safety when using a wheelchair or when being hoisted, and burns and scalds. However, risk assessments do not appear to be determined using a recognised or even any risk tool. Future assessments of risk need to be completed using a risk tool to determine the frequency and likelihood of risk so that a plan to reduce the risk can be decided upon and implemented. Decision making is greatly encouraged and features a lot in poeples lives on a daily basis, often linked to their care plan goals. People spoken with say they make many daily decisions and either follow their care plans or do not, but they risk things going wrong if they dont follow them. They recognise the support they need and acknowledge that care plans are in place for a reason and to aid them achieve their goals in life and to be independent. Daily diary notes show evidence of how care plan action plans are met and of how support is given to people to help them achieve their goals and be independent. Staff fully understand their responsibilities in supporting, encouraging and enabling people. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive very good support in taking part in appropriate activities and pastimes in the home and in the community and in making and enjoying appropriate relationships. People are well respected, can exercise their rights if they wish, and benefit from good nutritious meals. Evidence: Discussion with the manager, one staff and two people living in the home, brief conversations with three others and viewing of case files, records and documents with permission shows people lead the lifestyle of their choosing, which they find very satisfying. People have very good opportunities to take up occupation and education in their local community. People are encouraged to attend education classes, day centres, Royal Mencap Society activities and functions and to seek part time employment where Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: possible. People have individual activity plans that are displayed for easy access on the back of the kitchen door and which they follow regularly. Three people attend Priory View centre, one attends Sewerby Park Outreach, two do drama classes and one works at the Mencap Office where they are doing NVQ in Customer Retail Care. Everyone in the home goes to Gateway Club on a Tuesday evening and to Mencap functions at the local rugby club for music nights and sports events if they wish. Stubblefields won the Mencap sports day competition in the summer and hold the cup for one year. People also take impromptu trips out shopping or for a coffee, to see their GP or dentist, or just to accompany someone else on their way to centre etc. The manager says no one expresses any specific wish to exercise their rights as citizens and therefore they choose not to vote. Anyone needing legal advice would be assisted to seek it. People have been on holidays in England and abroad in the past and stayed at such as Haven Holiday Parks and Disney Paris, but this year they chose to have a series of day trips out to a working farm centre at Flaxton and to other costal resorts, Flamborough etc. There are also activities within the home, feeding the seven geese, three dogs and two cats, keeping bedrooms tidy, helping in the kitchen with meals and clearing away, watching television or DVDs, listening to music, playing card or board games, conversing and sharing time together. There are seasonal parties and festivities for such as Easter, Halloween, bonfire night and Christmas and people are also able to bring friends to visit. People are encouraged to have relationships with friends and partners if they wish to and if they develop a particular liking for someone, and all necessary support and guidance is provided. People keep in touch with relatives via telephone or letters and cards and they sometimes visit relatives and stay over. Whatever people choose to do they are supported in achieving it. Routines are very important to people in the home in order to maintain their sense of wellbeing and achievement, but they are led mainly by the people themselves. There is room for flexibility and where necessary people are supported to make changes in routine. People have the freedom to wander around the house and gardens and into each others room when invited. They confirm they have choices and the freedom to make their own decisions on activities, pastimes and occupation, and diary notes Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: record this. Meals are discussed in house meetings and people say they are very satisfied with the food provision in general, as they choose what goes on the menu and help with the shopping and preparing of meals where possible. They also say they are trying to eat healthily and or to reduce weight. One person is trying to learn basic cooking skills and a little more so they can possibly move to independent living, budgets for meals and often cooks their own food. People eat a snack for lunch and have a main hot meal in the evening, which is usually cooked by one of the staff assisted by a couple of people living in the home. There are no adverse comments about meals and people say they are quite satisfied. Care Homes for Adults (18-65 years) Page 17 of 32 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. People receive the personal care and support they need, have satisfactory health care needs monitored, though health action plans are needed to reflect and meet current health needs more effectively, and they benefit from robust and safe systems for handling medication. Evidence: Discussion with the manager, one staff and people living in the home and viewing of case files, records and documents with permission shows there are satisfactory systems in place to provide personal and health care support how people want it, but also that these systems need to be updated to reflect current trends in practice and more importantly to reflect peoples current and changing needs. Systems for handling medication are good. People are encouraged to speak up and make known what their needs are and how staff can best help meet them. Care plans show what support is needed with personal care and it is always provided in the privacy of a bedroom or bathroom. People say they receive care and support in the way they wish to and are encouraged to make decisions about rising, going to bed, what they eat, where and when they go out etc. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: They sometimes need guidance on maintaining personal hygiene but always decide what they want to wear and how they want to look. There is usually one male and one female staff available for people needing assistance so people do have a choice of support from either gender. Specialist equipment would be obtained for meeting peoples needs but at the moment there is none required other than a wheelchair and a hoist for one. Everyone manages to communicate well and there is a key worker system in operation. Health care needs are included within the general care plans in place and any specialist need is attended to or supported by health care professionals as necessary. People are encouraged to manage their health care wherever possible and attend appointments, screening and treatments with the support of staff. Records of all GP visits and appointments at out patients etc. are maintained for reference and as a history. People say they go to the dentist or opticians regularly and when they need to and that they can access their GP satisfactorily. If any other health care support is needed, say from the District Nurse or the Community Nurse for Learning Disability, it is accessed. There are no separate health action plans in place and if the home decides to implement new person centred care plans, as is recommended in the section on Individual Needs and Choices, then that would be a good time to introduce health action plans as a separate document. This would greatly improve the homes care and health care plan systems: assessing, recording and monitoring. The home does have a basic patient passport form, which contains peoples health details and which is sent with a copy of their goals to the hospital should they need to be admitted. Also within case files are records of hospital discharge notes, visits to dentist etc. and guidelines for staff regarding any specialist action or health care for specific conditions. There is a medication administration policy and procedure in place and staff receive appropriate medication administration training through Learn to Excel. The last time one staff did the course was May 2006, another did it in November 2008 and two recently did it in October 2009. Because staff medication training is a little out of date for two of them there needs to be either a refresher course completed by the two concerned, or a competence assessment undertaken each year for everyone. Indeed this competence assessing of staff for safety and capability in handling medicines should be carried out each year by the manager and recorded anyway. Medication is stored in a locked cupboard and administered from a monitored dosage system with Lloyds Chemist. There are only four people taking medicines at the moment and no one self medicates, except for one person who gives his own insulin Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: injections and one person takes a single dose of tablets out with him when he needs to. There are no controlled drugs in the home but there is a facility to lock these away if necessary. A control drug register would need to be obtained if any were prescribed. There are medication administration record sheets in use, which are appropriately signed and a list of any drugs returned to the chemist is maintained and signed for on collection. Systems are kept simple and appear to be well managed. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good systems in place to complain or make representations, and they are kept fully informed. There are good records maintained and staff understand how to pass on complaint information. There are also good systems in place to protect people from abuse and to pass on referrals to the appropriate authorities on safeguarding. Evidence: Discussion with the manager, one staff and people in the home and viewing of documents and records on complaints and safeguarding shows there are good systems in place and in use for people to represent themselves and to be protected from the risk of abuse or harm. There is an up to date complaint policy and procedure in place and staff demonstrate in interview they know how to handle complaints or concerns. Records are also maintained and show there has been no complaints made in the last three years. People spoken with say they know how to complain, who to complain to and when. They are used to a culture of speaking up when it matters and having issues resolved fairly quickly without recrimination, so concerns do not become major complaints. There is a safeguarding policy and procedure in place that staff are aware of and would implement. They demonstrate in interview an understanding of their responsibilities regarding allegations or suspicions of abuse etc. There has been one safeguarding referral in the last three years concerning neglect of personal care, which Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: was not upheld as neglect, but considered to be poor practice on one occasion. The home has given an assurance the situation will not reoccur. People spoken with know how to make their views known and say they have no worries about telling the home owner or any of the staff that they are unhappy about something or that they believe they have been exploited or abused in some way. People also say they have alternative contacts at such as day centres, work placements etc. where they can pass on concerns, so they feel well protected. Staff files viewed with permission show more than half of them have completed safeguarding training in December 2007 and November 2008. There are two staff new in post and they still need to complete the course. Meanwhile the manager should make sure all staff have an annual competence check on their understanding and awareness of safeguarding issues, allegations or suspicions, and that this is recorded as evidence. Care Homes for Adults (18-65 years) Page 22 of 32 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. People live in a good, homely environment that is clean, comfortable and safe. Some upgrading of decoration and furnishings is now beginning to be needed. Evidence: Dsicussion with the manager, one staff and people in the home and viewing of some of the communal parts of the home and two peoples bedrooms shows the environment remains clean and comfortable, but may now be in need of redecoration and upgrading. Stubblefields remains a family home for the people living there, many of them having been there for a considerable number of years. It is clean, comfortable and homely, but is now beginning to need some redecoration and upgrading of furniture and fittings. Nothing is obviously broken or in need of total replacement but furniture is looking tired and decoration is looking dull. One person spoken with says it has been some years since their bedroom has been redecorated. Perhaps next year could see some refreshing of the decor and furniture. A recommendation on the last inspection report to produce and review where necessary risk assessments for the hot water outlets and for the covering of radiators, was not checked on the day of the site visit, so a telephone conversation with the Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: manager was carried out before this report was completed. There are risk assessments for using hot water and for having unguarded radiators and all of these have been reviewed and updated. Two showers in use in the home have temperature control buttons, but baths do not have any such control valves. The manager is soon to upgrade baths and is therefore willing to consider thermostatic control valves. Where risk assesments identify the need for such valves they should be fitted and so this remains a recommendation of this report. The home remains clean and comfortable however. There is a small laundry which is mainly used by the staff though one or two people in the home do like to assist with laundry chores or to iron their own personal clothing. The laundry has washer, dryer, ironing board and iron and is mainly of domestic quality. It is easily cleanable. Staff have a good understanding of infection control safety and their practice is good. Care Homes for Adults (18-65 years) Page 24 of 32 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. People benefit from sufficient numbers of staff on duty at all times to meet their needs, from well recruited, qualified and trained staff, that are adequately supervised. Evidence: Discussion with the manager and one staff and viewing of staff files and documents with permission shows there are appropriate systems in place and in use to ensure staff are well recruited, have the right qualifications, are employed in sufficient numbers and are satisfactorily trained. There are two staff with NVQ level 2 in Care and two more doing it, there is one staff doing level 3 and the provider has Certificate in Social Services. Since there are only four staff employed, the home has 100 care staff with or doing the recommended qualifications. There are only a small number of staff employed and working at Stubblefields as it continues to be a family run business where the providers and their daughter and three other staff care for and support people living there. Of the four staff actually employed on day shifts two share the sleep-in duty with the providers. There is no necessity for waking night carers as everyone in the home sleeps well at night. Usually one provider and one carer are available in the home when people are there during Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: the daytime, but when everyone is out there may only be the provider on call or one carer working alone. The roster system has worked well for many years. The staff team is adequately deployed to ensure there are sufficient numbers of carers or providers on duty throughout the waking day and on call at night. There is a recruitment and selection policy and procedure in place and practice is generally good in following them. Two new staff recruitment files were viewed with permission to determine the required checks are made etc. They evidence that staff complete an application form, references are obtained, though for one person they are a testimonial and a character reference as she came straight from college. POVA firsts are taken up, CRB checks are done, and induction is undertaken, while training and supervision are offered, though supervision was not checked. There is evidence in files that staff receive a copy of the General Social Care Council code of conduct, a contract of employment, a job description, a mission statement, a disciplinary procedure and a Health & Safety instruction on fire safety. Training and development opportunities are available for doing qualifications and mandatory courses. Staff confirm they have had medication administration, safeguarding adults, equality and diversity, fire safety training etc. Care Homes for Adults (18-65 years) Page 26 of 32 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. People benefit from an experienced and trained manager in post, that uses a QA system to determine the service performance. The home is well maintained and safe working practices prevail, and these are evidenced in certificates and monitoring checks on safety that are well recorded. Evidence: Discussion with the manager and viewing of some quality assurance documents and maintenance certificates, records and documents shows the home is being well run and there are satisfactory systems in place to quality assess the service and to promote and protect the health, safety and welfare of people and staff. The registered provider is also the registered manager and runs the home with support from her husband and daughter as well as three other employed staff. The manager has a Certificate in Social Services, a residential social working qualification, equivalent to Diploma in Social Work, and has many years experience working with and caring for people with a learning disability. From the evidence viewed in the home in respect of care plans, risk assessments, health action plans, etc. it transpires that Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: she may need to update herself in the current trends and practices of supporting people with a learning disability. There is no doubt that the manager produces a home ethos that is enabling for people in respect of their personal and social lives and that they are fully included in society and their local community. There is also a very steady, consistent and calm approach to providing the service, which enables people to maintain a good routine, to solve problems as they arise and to experience new ideas and situations confidently. Stubblefields has a quality assurance system in place, which along with other systems has been awarded the East Riding of Yorkshire Council quality development scheme payments for parts one and two. The system involves keeping the statement of purpose and complaint procedure up to date, has set quality standards and a mission statement and an action plan for the year to Jan 2010. There is a training and development schedule for staff, an environmental checking system, house meetings, and annual questionnaire surveys that have been presented to care coordinators, family members and the private and voluntary sector, but not people in the home yet. These are still to be done. The home also uses the services of a company called Motivation and Co, which offers a regular motivation group meeting to discuss and do different pastimes and activities. Systems were not tested for effectiveness, but it is understood the quality assurance of the service is appropriate and carried out annually. There are general health and safety systems in place that protect people and staff and promote their welfare. A sample of these were viewed and covered fire safety checks and drills, water temperature and storage, window safety, hoist maintenance, accident reporting and gas and electrical safety. All of these, except a legionella water test, are covered by appropriate checks, records and certificates. Recommendations made at the last inspection to make sure there are risk assessments on the hot water outlets or that thermostatic control valves are fitted, and on the unguarded radiators, has been actioned. Two showers in use have control buttons to prevent water being too hot, but two baths do not. The manager is renewing one bath and will consider making sure control valves are fitted to both bath outlets at the time the one bath is replaced. Radiators have risk assessment documents in place and these show there is very low risk to people. One new recommendation is made in this report to ensure a legionella water test is carried out on the hot water storage system and a record maintained as evidence. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 The registered provider should make sure there is a person centred assessment format to follow, including details in standard 2.3, in the event someone privately paying for their care wishes to move into the home, so everyone is confident their care and health care support needs are assessed and met. The registered provider should make sure contracts of residence are reviewed and updated with people and families to reflect current situations of people and the service, so people have their residency protected. The registered provider should make sure people have person centred care plans and risk assessments that follow a recognised format and template, so their needs are recorded using current trends in good practice and so people are confident their needs are being well met. The registered provider should make sure all risk assessments are completed using a recognised risk tool, to dertermine the frequency and likelihood of risk in order to decide upon how risk will be reduced. Also so people know the risks they may take are reduced where possible. 2 5 3 6 4 9 Care Homes for Adults (18-65 years) Page 30 of 32 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 5 19 The registered provider should implement health action plans to reflect and meet peoples current health care needs more effectively and so people know their health needs are being well met. The registered provider should consider some upgrading of decoration and furnishings so that people have an improved environment to live in. The registered provider/manager should make sure she is aware of and practices the current trends in recording and reporting the caring and supporting of people with a learning disability, so they are confident their needs are being well met. The registered provider should make sure there is a legionella water test carried out on the hot water storage system so people know they are protected from the risk of harm from disease. 6 24 7 37 8 42 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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