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Care Home: Sue Ryder Care Centre

  • Holme Hall Holme On Spalding Moor East Yorkshire YO43 4BS
  • Tel: 01430860904
  • Fax: 01430869591

The premises, known as Sue Ryder Care Home is a Grade II listed building set in extensive grounds and has a small catholic church attached to the premises, to which the local community attend. Accommodation is currently provided on three floors; bedrooms are situated on the first and second floors with lounges and other communal areas on the ground floor. Access to the upper floors is by use of staircases or the two passenger lifts. There are large and well tended garden and patio areas around the home and people enjoy sitting outside in the better weather. Ramps and flat walkways are provided to make it easier for people with mobility problems to access the outside areas. Information given by the manager during this visit indicates the home charges fees from 706.00 GBP to 1264.85 GBP a week depending on individual care needs and the nursing input required. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are given to every person on admission. The latest inspection report for the home is on display in the entrance hall and copies are available from the manager on request.

Residents Needs:
Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Sue Ryder Care Centre.

Key inspection report Care homes for adults (18-65 years) Name: Address: Sue Ryder Care Centre Holme Hall Holme On Spalding Moor East Yorkshire YO43 4BS     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: Eileen Engelmann     Date: 1 2 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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: Sue Ryder Care Centre Holme Hall Holme On Spalding Moor East Yorkshire YO43 4BS 01430860904 01430869591 linda.chapman@suerydercare.org www.suerydercare.org Sue Ryder Care care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home The premises, known as Sue Ryder Care Home is a Grade II listed building set in extensive grounds and has a small catholic church attached to the premises, to which the local community attend. Accommodation is currently provided on three floors; bedrooms are situated on the first and second floors with lounges and other communal areas on the ground floor. Access to the upper floors is by use of staircases or the two passenger lifts. There are large and well tended garden and patio areas around the home and people enjoy sitting outside in the better weather. Ramps and flat walkways are provided to make it easier for people with mobility problems to access the outside areas. Information given by the manager during this visit indicates the home charges fees from 706.00 GBP to 1264.85 GBP a week depending on individual care needs and the nursing input required. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 40 40 Brief description of the care home Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are given to every person on admission. The latest inspection report for the home is on display in the entrance hall and copies are available from the manager on request. 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: Information has been gathered from a number of different sources over the past 24 months since the service had its last key visit on 17 August 2007, this has been analysed and used with information from this visit to reach the outcomes of this report. There was an additional visit by an inspector on 23 July 2008 in response to a complaint about care practices and how the manager dealt with complaints. The outcome of this visit was that the complaint was not upheld. A report was produced as part of this visit, which can be obtained by interested parties from the Care Quality Commission or from the manager of the home. We completed an Annual Service Review (ASR) for the Sue Ryder Care Centre on 11 August 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. Care Homes for Adults (18-65 years) Page 6 of 32 The published review is a result of the assessment and does not come from our power to enter and inspect a service. As the registered manager for the service was on leave, this unannounced visit took place with the head of care, staff and people using the service. The visit included a tour of the premises, examination of staff and peoples files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home, social and health care professionals and staff. Their written response to these was adequate. We received 10 from staff (100 ), 2 from social care professionals (40 ) and 6 from people using the service (30 ). Informal chats with staff and people using the service took place during this visit; their comments have been included in this report. The service completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. 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: 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 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. People told us in the surveys that they were consulted before they decided to come into the home and were given sufficient information about the service to make an informed choice. One person said I feel the home is the best place for me, the staff are friendly and it has nice surroundings. In each of the four care plans looked at during this visit there was a copy of the community care assessment and Local Authority care plan. People coming into the Sue Ryder Care Centre undergo a needs-assessment carried out by the head of care or Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: senior nurse before they are offered a placement at the home. The assessment includes a full discussion with the person, carer and/or family, to look at what needs the person may have and what the home can provide so individuals have a good understanding of the service and what they can expect to receive from it. Information gathered from the needs assessment is then used to develop a detailed and descriptive care plan. Input from other professionals and/or family is also recorded and each plan is individualised to the person using the service. Information given to us in the Annual Quality Assurance Assessment (26/5/09) and through discussion with the head of care is that, wherever possible individuals thinking about moving into the home are encouraged to visit the service to meet the staff and other people living in the home before making the decision to come in permanently. Where a person is unable to visit the home the head of care or senior nurse will meet with them before they are admitted so they see a familiar face when they come into the service. At all times leading up to admission the home liaises with commissioners, the individual and their families, the centres multi-disciplinary team including the local GPs, in an effort to obtain all views and reduce any anxieties the person may have over coming into care. Information from the Annual Quality Assurance Assessment and discussion with the head of care indicates that the majority of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the head of care indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. People using the service are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home employs 2 male care staff. Discussion with people indicated that they have a good relationship with the staff and are comfortable in asking for specific individuals to deliver their personal care. Peoples preferences for staff gender and age when giving personal care should be documented in the individual care plans. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Comments from the surveys were that we care for people in a relaxed, homely atmosphere and one relative said the staff have enabled me, through offering training and support, to be completely involved in all relevant areas of my relatives life. This is my second home. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a wide range of more specialised subjects that link to the needs of people using the service. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. 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. The health, personal and social care needs of the people living in the home are clearly documented and are being met by the service and staff.The care plan sets out in detail how all their current requirements and aspirations are to be met through positive individualised support. Evidence: Information given to us in peoples surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. Comments from the surveys said the service treats all people with respect and looks after them well, promoting high levels of personal hygiene for people using the service and the staff enable people to live within the home as flexibly as possible, with as much independence and freedom as possible. The care of four people was looked at in depth during this visit and included checking of their personal care plans. Each individual using the service has a detailed, Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: descriptive care plan, which identifies their individual needs and abilities, choice and decisions and likes and dislikes. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. Any changes in care are documented and actioned by the staff. The care needs and wishes are discussed with the person, their family or carer (as applicable) on a regular basis and any comments or different choices agreed are put into the plan. In response to the Mental Capacity Act and Deprivation of Liberty legislation, the home has developed documentation to support information collection with regard to whether a person has, for example, an advanced care decision or Enduring/Lasting Power of Attourney in place. Mental Capacity Act documentation has been developed to support assessment of capacity to make specific decisions and to support and record best interest decision making where a person lacks capacity. Staff have access to training through an e-learning package and associated information on the Sue Ryder Care Intranet. Reviews of care with the families, person living in the home and care co-ordinator from the local authority are taking place and minutes of these meetings are in the plans. Minutes of Best Interest meetings are available in the care plans, these take place when informed choice cannot be made by the individual and includes the views of all those involved in the individuals care. One person whose care plan we looked at has a Deprivation of Liberty Safeguarding Authorisation in place, this was drawn up by the local authority and is to be reviewed on a monthly basis. Staff enable people to take responsible risks in their every day lives and information within the care plans includes a number of risk assessments covering activities of daily living, use of equipment and personal safety information. One individual we spoke to enjoys going outside of the home in their electric scooter, travelling to the local village, shops and public houses. Risk assessments are in place around this persons safety and wellbeing. Staff have had training around equality and diversity, Deprivation of Liberty, Mental Capacity Act and Protection of Adults from Abuse. This knowledge and information is used to ensure that peoples choices and human rights are maintained and that any limitations on facilities or personal choice are only made following assessment, best interest meetings, risk assessments and discussion with the person concerned or their representative. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. They can access and enjoy opportunities in their local community such as public transport, library services and the local pub. Evidence: At the time of our visit (12 August 2009) there was no-one using the service who was attending any educational courses, due to their physical disabilities. People are able to access a range of social and leisure activities including trips out, shopping at the local community facilities, craft sessions with the activity co-ordinators and events taking place in the local community. The head of care told us that a new coffee shop is opening up in nearby Holme Upon Spalding Moor and regular film nights and a chess club are to take place, which people living in the home are looking forward to attending. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The home has a minibus with regular outings on a Monday and Thursday, the bus can be booked for other days by appointment. There is a local bus service into Market Weighton on a weekly basis and to York on a daily basis. Sue Ryder is a registered charity and regularly participates in fundraising activities, which involve garden parties, coffee mornings and raffles. There are a number of volunteers from the local community who come to do activities with people or assist in the fund raising events. Individuals have access to computers within the lounges and these have broadband connections so people can e-mail friends and relatives as they wish. A number of people living in the home have their own computers in their bedrooms. The home has provided people with a large plasma screen in one of the lounges, and this includes a range of equipment for people to use with the television, DVD players and other games consoles. People in the room can use it as a touch screen, or there is a range of hand controls and different keyboards to accommodate peoples physical disabilities. At the time of our visit three people were sat watching a music programme and were busy singing along to the tunes. Three other people were using the recreational room to make chocolate crispy buns and they then used the computer to access a range of recipes for desserts that did not require baking. There are pet birds at the home and one person using the service has their own budgie in their room; the staff assist the people in the home to look after these pets . The home employs three people to carry out occupational therapies on a monday to friday each week, there is a set programme of activities and this is on display in the recreational room. Feedback from people, relatives, social care professionals and the staff indicates that although the current recreational help and input is good, there is a need for more creative and diverse ideas. People said the recreational activities on offer are basic and undemanding and I would like to see more physiotherapy, water therapy and 1-1 input with individuals. Discussion with the head of care indicates that the service is aware of the shortcomings of the recreational activities, and that there is a lack of things for people to do on weekends and evenings. This is being looked at by the service, and at the moment there is a recruitment drive for more volunteers to carry out a wider range of social activities. People living in the home have been encouraged to make a wish list for activities and staff are busy working through these. One individual has gone to a football match and another to the theatre as part of this process. A Catholic Church is attached to the home and is used by people from the community as well as individuals in the home. Peoples different spiritual needs are met by arranged visits from the specific clergy. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: People living in the home are encouraged to maintain contact with family and friends, there is no restriction on visiting times and relatives/friends are invited to join in with social activities and events. One relative told us I am able to visit my relative on a daily basis and for long periods of time, two other people were participating in the lunch time meal with their family member and said that we are always made welcome by the staff, they are good at letting us know if anything happens to our relatives and we are encouraged to join in with daily life in the home. People spoken to are very happy with the way that staff look after them, they felt that they are given choices in their everyday life and staff respected their privacy and dignity. Observations of the interaction between staff and people showed that there is a good relationship between the two groups based on trust and friendship. Bedroom doors are supplied with simple locks and the staff respect the fact that people need time alone or with their partner/family. People receive good support in the meeting of their dietary needs. We observed the lunch time meal which was relaxed and unrushed, with individuals being offered good support with eating their meals. Peoples dietary needs are assessed and if necessary records are kept of food and fluid taken by the individual. Observation of the lunch time meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft diets in an attractive way. People and relatives are pleased with the quality and quantity of the meals served, saying the food is very good and there is always a choice given. 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. Peoples personal and healthcare needs are met through good inter-agency working and by the staff having a sound knowledge of each individuals needs. Staff ensure that care is person led, personal support is flexible, consistent and is able to meet the changing needs of the people using the service. Evidence: Information, within the care plans looked at, shows that each person has their own preferred daily routine including their choices and wishes regarding care giving. People we spoke to said they were satisfied with their care and feel their needs are being met. Aids and equipment are provided following assessment by occupational therapists, physiotherapists and other health care professionals; people are reviewed regularly to meet any changes in need. People in the home are able to access health care through the local GP, dieticians, district nurses and specialist health professionals. Where an individual requires specific care such as postural management or epilepsy management, a detailed plan of how this is to be achieved can be found in each persons care plan. Staff have attended specialist neurological courses over the past 12 months and staff training is focused on the needs of people using the service. Staff work closely with external professionals such as the Motor Neurone Disease Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: specialist nurse, Huntingdons advisor and the Epilepsy specialist nurse. Equipment is available within the home to assist people in maintaining their independence. This includes computers, mobile hoists and overhead hoists, electric wheelchairs, specialist beds and mattresses, bedrails and bumpers and a nurse call system with large buttons on the handsets.Two people using the service have specialist systems in their bedrooms, to help them control their bed, switch on/off the television and use the computer/stero equipment. Three more people are waiting for this type of system. People have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that people and relatives are satisfied with the level of medical support given to the people living at the home. Relatives commented that they are kept informed of their relatives wellbeing by the staff; they are regularly consulted (were appropriate) on their care and feel involved in their lives. Overall there is a good level of satisfaction with the care being given to the people using the service. The home has changed its medication supplier since our last key visit in August 2007, it is using a Monitored Doseage System (MDS) or pop out system for its tablets and has some boxes and bottles for medication that cannot be put into this type of heatsealed system. Checks of the medication records showed that the majority of the documentation is satisfactory, but there are a few areas where practises could be improved. One person who was in on respite did not have the quantities of medication brought in recorded by the staff, which would make it difficult to audit if any errors occurred. Where staff are handwriting medication onto the MAR sheets (transcribing) there should be two staff initials against the information to show that two people have checked that what is written (medication name, strength of medication, type of medication such as tablet or liquid, and how it is to be administered) is clearly and correctly recorded, and matches what is on the medication packet or bottle from the pharmacy. There were a number of missing signatures where staff have administered medication but have forgotten to sign the medication chart to say it has been given, this could lead to lead to medication errors occurring. Where medication is to be given on an as and when basis (PRN) there needs to be written information from the pharmacist or doctor about how the medication is to be given and under what circumstances should it be given. We found one person was written up for diazepam, but there were no instructions about its administration, no quantities recorded of the stock held and no signatures from the staff to say when the medication had been Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: received. Checks of the controlled drugs records found these to be up to date and accurate. 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. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: There is a good complaints system available and on display within the home, which supports the people living in the home or their representatives to be able to raise any concerns and be confident that these will be dealt with appropriately. The policy is available in a number of different formats on request. Checks of the complaints record shows that the manager has dealt with 3 complaints in the past 12 months. These have all been investigated and resolved, with a written response from the manager to the complainants. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said we are able to talk to the staff or head of care on a daily basis, they listen to us and will take action on any issues raised. The staff demonstrated a good awareness of the process to safeguard the people in the home from abuse. The staff training files we looked at indicate that the majority of staff have received training on protection of adults from abuse, most have attended Mental Capacity Act briefings and all have access to information on Deprivation of Liberty Safeguards. The home has policies and procedures to cover adult protection Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. We spent some time during this inspection talking to the head of care about the need to send in regulation 37 reports and complete safeguarding alerts when people using the service displayed aggressive behaviour towards each other, so that a clear record of incidents could be maintained. We recommended that staff attend management of challenging behaviour training to ensure they have the skills and knowledge to meet the needs of the people living in the home. 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. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles. Evidence: Sue Ryder Care Centre is a grade 2 listed building set within a rural community, close to a small village. It has extensive grounds of which some are not accessible to people who live there. A number of people use electric wheelchairs and they are able to independently move around the home using the two passenger lifts, which are fitted with low set buttons specifically for wheelchair users. There is a mix of large and small communal areas giving people options of where they wish to sit and a chance to enjoy quiet times as well as company. Bedrooms are large and spacious enough to accommodate the equipment needed to move individuals about during care giving. People have a choice of bathing facilities including rise and fall baths, a jacuzzi bath and showers. An overhead tracking system is fitted within the bathrooms, to aid staff when hoisting people into and out of the baths. Outside the home is a range of well tended gardens and flat walkways, including a sensory area with lights, a water feature and fragrant plants. This area can be accessed from different areas of the ground floor. On the day of our visit people were seen out on the patio area enjoying the sunshine, a gazebo was covering part of the Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: area to offer individuals shade if required. In response to requests for improved security a special locking system has been added to the main entrance, which people can override to allow access. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home. This includes mobile hoists, over-head hoists, slide sheets, moving and handling belts and handrails. Storage rooms for equipment are provided throughout the home. Bathrooms are fitted with rise and fall baths and Jacuzzi baths and all areas have wide doorways to enable wheelchair access. Specialist nursing beds including profiling and rise and fall adaptations are provided where people have an assessed need, and these aid staff in caring for these people and make life more comfortable for individuals who spend a lot of time in bed. The home provides pressure relieving mattresses and cushions, where people are deemed at risk of developing pressure sores. The passenger lifts are specific to the needs of the people in the home, one is large enough to take a bed and the other accommodates wheelchair users. There is a relaxation room and a recreation room for people to use, which are supplied with equipment and specialist adaptations for use with people with disabilities. All areas seen during this visit were found to be warm, safe and comfortable, well decorated and welcoming. The home has an infection policy in place and staff receive training around this area of practice. Comments from the day of this visit indicate that the people using the service find the home to be spotlessly clean and they are satisfied with the laundry service provided by the home. 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. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: Information gathered from the Annual Quality Assurance Assessment and from staff surveys indicates that the home has been using a lot of agency in the past few months and staff feel that there are not enough people on duty, which is impacting on the amount of 1-1 time they have with individuals. Discussion with the head of care indicates that the home has been busy recruiting for new staff and at the time of our visit 10 new members of staff were due to complete their inductions and start work within the home. Feedback from people using the service and relatives remains positive about the service and the staff. At the time of our visit (12 August 2009) the staffing levels within the home were as follows, on the early shift there are two nurses and eight care workers, on the late shift there are two nurses and six care workers and at night there are two nurses and three care workers for 34 residents. Using information about dependency levels provided by the head of care at the this visit, checks against the residential staffing forum guidelines for a physical disability home shows that the home is meeting the Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: minimum recommended staffing hours. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. The home offers staff a wide range of specialist training aimed at meeting the needs of the people who live in the home, in addition to a comprehensive induction and foundation programme, which meets the Skills for Care training targets. 35 of the staff have achieved an NVQ 2 or above in care. Staff receive in excess of three days paid training per year and the home has individual staff training plans that are discussed through supervision and appraisal. Information in the Annual Quality Assurance Assessment completed by the service on 26/5/09 indicates that they recruited an educational lead in September 2008 and this individual has been working on a part time basis. 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. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The service has notified us that the registered manager is on long term sick leave and in the interim the home is being managed by an acting manager and the head of care. The head of care is in charge of all clinical care within the home and takes over the management role when the acting manager is not available. Discussion with the staff and people using the service indicates that they are satisfied with the management arrangements in place and feel supported by the people in charge. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The acting manager and head of care complete in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and a development report is produced as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. 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 1 20 13 The registered person must 01/12/2009 ensure that records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. So people in the home can be confident that their health and well being is promoted and protected by the practices of the home and its staff. 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 3 The manager should ensure that information about peoples preferences regarding staff age and gender for giving personal care, is recorded in the individual care plans. The manager should ensure that where staff are handwriting medication onto the MAR sheets (transcribing) there are two staff initials against the information to show that two people have checked that what is written Page 30 of 32 2 20 Care Homes for Adults (18-65 years) 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 (medication name, strength of medication, type of medication such as tablet or liquid, and how it is to be administered) is clearly and correctly recorded, and matches what is on the medication packet or bottle from the pharmacy. 3 20 The manager should ensure that where medication is to be given on an as and when basis (PRN) there is recorded information from the pharmacist or doctor about how the medication is to be given and under what circumstances should it be given. The manager should ensure that staff attend management of challenging behaviour training, so that they have the skills and knowledge to meet the needs of the people living in the home. 4 23 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. Care Homes for Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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