Care Home: Summerhouse

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What the care home does well Residents we spoke to told us they are happy in the home. One resident told us that they like the home because they can come and go as they please. Residents receive personal support from a stable team of staff who know the residents well and have a good knowledge and understanding of the health care needs of the residents. The home works well with community mental health services to make sure that residents receive the health care they need. What has improved since the last inspection? The home has taken action to comply with previous regulatory requirements: medication procedures have improved, care and support plans are reviewed each month with the resident and their key worker, risk assessments and management plans have improved, residents have more opportunities for leisure and social activities. Staff recruitment procedures have been reviewed and staff training has been updated in some areas of safe working practice such as moving and handling. Staff have received training in the practice of the mental capacity act. Systems for ensuring that hot water is safely regulated have been installed. The responsible individual is carrying out monthly inspections of the home. What the care home could do better: The registered person must continue to ensure that medication procedures in the home are regularly checked and residents receive their medication safely and as prescribed. Improvements to all areas of practice must be sustained and the home must demonstrate that improvements will be embedded in the practice of the home. The home needs to continue to develop a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives and visitors. This will demonstrate that the home has a process for continual review and improvement to provide good outcomes for the people living in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Summerhouse Summerhouse Guyers Road Freshwater Isle of Wight PO40 9QA     The quality rating for this care home is:   one star adequate 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: Annie Kentfield     Date: 1 7 0 7 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 24 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 24 Information about the care home Name of care home: Address: Summerhouse Summerhouse Guyers Road Freshwater Isle of Wight PO40 9QA 01983755184 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Make All Ltd care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 11 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Summerhouse is a registered care home providing care support and accommodation for up to eleven adults with mental health needs. The home is a two storey detached period house located in a quiet residential area of Freshwater, close to bus routes. It is less than a mile from the amenities and shops of Freshwater town and the coastal amenities of Freshwater Bay. Summerhouse is suitable for residents who are fully mobile, as there are steps to the front door and no lift to the first floor. Many of the residents have lived at the home for a number of years and have regular contact with health and social care professionals. Most rooms are for single occupancy and are Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 11 2 3 0 1 2 0 0 9 Brief description of the care home arranged over the ground and first floors. Bedrooms are not en-suite but all have a wash hand basin and residents have access to bathrooms and toilets on each floor. Residents have a communal lounge on the ground floor. The home has installed a new kitchen and this means that residents now have a separate dining room. There is a garden with seating areas for residents to use. Information about fees and any additional charges are available from the home. Care Homes for Adults (18-65 years) Page 5 of 24 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to the home on 17 July 2009 and one inspector was in the home for four hours. Six residents were involved with the inspection and we also spoke to the manager and two members of staff. We looked at medication and care planning records, staff training and recruitment records and some of the health and safety records. We received the annual quality assurance assessment in January 2009. This is a self assessment that provides us with information about the service and what the service does well and where further improvements are planned. Care Homes for Adults (18-65 years) Page 6 of 24 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 7 of 24 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 8 of 24 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 do not move into the home without their care and support needs being assessed and the home is confident they can meet those needs. Evidence: We did not assess this area of practice as there has not been any new residents moving into the home. However, we know from previous inspections that the manager has a good understanding of the importance of pre-admission assessments and that other residents have been invited to visit the home several times before making the decision to move in. Care Homes for Adults (18-65 years) Page 9 of 24 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. Residents are supported to make choices about all aspects of their daily lives and staff promote and respect their rights and choices. Evidence: The Annual Quality Assurance Assessment that was completed by the manager told us Summerhouse has an open door policy and friends and family are always welcome. Rights and choices are respected because residents are encouraged to be fully independent and to lead full and active lives. We spent time with five of the residents who were in the dining room or the lounge. People told us that they could do what they wanted and one resident told us that they liked the home because I can can come and go as I please. Some of the residents prefer to go out on their own and other residents like to go to organised events; one resident had been to a local day centre where there is the opportunity to to do arts and crafts and cooking. We spoke to staff in the home who said that residents likes and dislikes are always respected and staff will support residents in whatever they choose to do. Residents are able to expresss their choices and preferences about daily living activities. Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: We looked at the support plans for three residents; these set out the care and support needs for each resident. The home has been in the process of developing person centred care planning and since the last inspection, the support plans have been updated and reviewed. Each support plan is reviewed three monthly and each resident meets monthly with their key worker to review ongoing issues and goals. The support plans contain evidence of consultation and discussion with each resident and have been signed by the resident, recording their personal goals, choices and preferences. Person centred care planning is still in the developmental stage and the home have not yet monitored and reviewed how outcomes have improved for people in the home. At the last inspection we said that the home is not always recording what action is being taken to minimise risks or events to ensure that residents are safe and we made a regulatory requirement. The home sent us an improvement plan and told us that they have reviewed risk assessments and risk management plans to include person centred risk assessments on an individual basis. We saw evidence of these in the care and support plans and the action that is being taken by staff to minimise risks or manage events to protect the residents. For example, one care plan contained a relapse plan so that everyone was clear about what they must do if a person experiences a relapse of their mental health. It was evident that the manager and staff work closely with community mental health services to ensure that residents receive prompt support when this is needed. Staff demonstrated a good awareness of residents mental health and changes in health from time to time. Care Homes for Adults (18-65 years) Page 11 of 24 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. Residents have opportunities to take part in social and leisure activities and there is a varied menu with choices of meals and snacks. Evidence: At the last inspection we said that care plans did not contain evidence of consultation with residents about their choices and preferences for social and leisure activities. The improvement plan told us that an activities co-ordinator has been appointed and there is now an activities programme. The home has developed personal care and support plans to also include what people would like to do and how they will be supported. During our visit, some of the staff and residents were involved in some games in the dining room and one resident showed us some of the art work they had done. Another resident enjoys doing some knitting. Some of the residents told us that they prefer to do things on their own. We spoke to staff who know the residents well and are happy Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: to support the residents to develop interests and activities of their choice. We were told that an outing to Monkey World in Dorset, had been arranged for residents who wanted to go. Some of the residents go to a local day centre and there is a range of events and activities on offer. Residents told us that they enjoyed the meals in the home. These are cooked by staff and there is a daily menu, but other choices are available if residents prefer. Residents are encouraged to have a healthy diet and we noticed that fresh fruit and healthy snacks were available. Drinks are available at any time. Care Homes for Adults (18-65 years) Page 13 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way that medication is managed in the home has improved to ensure that residents receive their medication as prescribed. The health and personal care needs of the residents are met with privacy and dignity. Evidence: At the last inspection we made a regulatory requirement because the home were not keeping complete and accurate records of medication received into the home, dispensed or returned to the pharmacy. Residents were not being safely supported if they were able to manage their own medicines. The home sent us an improvement plan and we found evidence of new procedures in place to ensure that there is a clear audit trail for all medicines. The medication administration records are checked daily and weekly to ensure that medicines have been dispensed and recorded. Medication that comes into the home is recorded, however, although the records had been signed, some did not record the amounts received. Separate records are kept of any medication that is self-administered. The manager has acquired a copy of current good practice guidance for the safe administration of medicines in care homes, however, the guidance is from 2003 and Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: there is more up to date guidance available. The home must demonstrate that improvements to medication practice and procedures will be sustained and embedded in practice in the home. This will ensure that residents health care and medication needs are safely and consistently met. Care records show that residents health care needs are met in a number of ways. Residents are supported to access their GP, dentist, optician and other health care services. The home works well with community mental health services to ensure that residents mental health care needs are regularly met and additional support arranged when needed. The manager ensures that residents attend health appointments or care reviews when these are due. We spoke to residents and staff and it was evident that residents choices and preferences for how they receive care is always respected. Care staff demonstrated a good knowledge of the residents physical and mental health care needs and it was evident that staff are aware of changes in health and take prompt action to ensure residents receive the support and treatment they need. Care Homes for Adults (18-65 years) Page 15 of 24 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 complaints procedure to follow in the event of any concerns or complaints. Residents are protected from the risk of harm or abuse. Evidence: At the last inspection we had concerns about the protection of residents because the home did not have a comprehensive system for identifying and managing any events or risks to residents. We also found that the home were not carrying out thorough recruitment procedures and some staff did not have satisfactory pre-employment checks. The home sent us an improvement plan and told us that recruitment procedures have been reviewed and all pre-employment checks are now in place to demonstrate that new staff are suitable to work in the home. The manager has improved the procedures for identifying and managing any risks and events and these are recorded in care and support plans. We have not received any complaints about the service and there has not been any reported concerns about the safety or protection of the residents, since the last inspection. Care Homes for Adults (18-65 years) Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe, homely and comfortable environment for the residents. Evidence: The home is small and domestic in size and this provides a homely and friendly environment for the residents. All of the residents that we spoke to expressed their satisfaction with the home. We discussed the hall and stairway carpet with the manager. The carpet is regularly cleaned but because of the light colour, it does not wear well with the amount of people using the stairs and hallway. It is evident that the home is suitable for the needs of the residents and there is an ongoing programme of replacement and decoration. The kitchen and dining room where residents spend a lot of time is attractive and comfortable and there are pictures produced by the residents displayed on the walls. Care Homes for Adults (18-65 years) Page 17 of 24 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 recruitment procedures for the home have been reviewed and updated to meet regulatory requirements and ensure residents are protected. Improvements have been made to the staff training programme to ensure that staff have the skills and competencies they need for the work they do. Evidence: At the last inspection we found that residents were not protected by robust and thorough staff recruitment procedures. The improvement plan told us that procedures have been reviewed and the manager has obtained pre-employment checks that were missing from some of the staff records. The home has not employed any new staff since the last inspection but the manager confirmed that the home would ensure that all pre-employment checks are in place before any new staff start working in the home. The home must demonstrate that improvements will be sustained and be part of good practice. This will ensure that staff are suitable to work with the residents and protect the safety and well being of the residents. The manager has produced a staff training matrix to easily check when training needs updating and when further training needs to be arranged. Since the last inspection all staff have completed training in safe moving and handling and the Mental Capacity Act. The manager and deputy are due to undertake further training in the Mental Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: Capacity Act - the deprivation of liberty safeguards. This will ensure that the manager and staff have the knowledge they need to understand how the new legislation may affect residents in the home. The manager confirmed that the home has a code of practice for the new legislation. We looked at records that confirm that staff receive regular supervision. We spoke to two members of staff who told us that they really enjoy working in the home with the residents. Staff enjoy the training and found the mental health training very helpful and would like to do more training. Comments confirm that staff feel supported and have sufficient training for the work they do. Care Homes for Adults (18-65 years) Page 19 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the residents. The home has started to develop a programme of self-review and consultations and these need to develop to demonstrate there are effective quality assurance systems that include the views of residents, staff, relatives and other people involved with the home. Evidence: Comments from residents and staff confirm that people feel confident about speaking to the manager if they have any concerns and the manager is experienced and approachable. Since the last inspection the home has taken action to improve practice in the home and ensure that residents are protected by the homes policies and procedures. Medication practice has improved and medication is regularly checked to make sure that residents receive their medication as prescribed and there is a clear audit trail for all medication received into the home. The management of any risks to residents has improved and records show that there is written guidance on how risk or events are to be managed to protect the residents. The procedures for recruiting staff have been Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: reviewed and staff training has been updated and staff have now received training in safe practice in manual handling. Social and leisure activities for residents are more structured and there is evidence that residents are consulted on what they would like to do. We looked at some of the health and safety checks and procedures that are in place: the fire alarm, emergency lighting and door closures are checked regularly. The last fire evacuation drill was carried out in February 2009 and the previous one was February 2008. The manager confirmed that the home has a fire evacuation plan and there is a fire safety risk assessment in place. The home sent us an improvement plan after the last inspection and confirmed that they have met all of the regulatory requirements. Mixer valves have been installed to hot water outlets to ensure that residents are not at risk from scalding. The responsible individual is carrying out monthly inspections of the home to ensure that the home is meeting legal requirements and meeting the needs of the residents. There are a number of checks and audits in place to monitor the practice in the home: medication checks, key worker reviews and care plan reviews, and the inspections by the responsible individual. The home have not yet developed the quality assurance systems to include regular consultation with residents and other stakeholders such as relatives, staff and health and social care professionals. The home must demonstrate that the improvements made will be sustained over a period of time and be embedded in practice in the home. This will ensure that residents health and well being is protected at all times. Care Homes for Adults (18-65 years) Page 21 of 24 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 22 of 24 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 Care Homes for Adults (18-65 years) Page 23 of 24 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). 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