Care Home: Swanborough House

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What the care home does well The home aims to rehabilitate people who have an acquired brain injury with the focus being on enabling them to return to the community. In the past year they have been successful in enabling some people to now live in either supported living or out in the community in their own apartments. The philosophy of the service is the Anthrosophical way of life which supports people in a holistic manner. This extends to all areas of life and well being, and includes specific treatments and therapies, and the provision of an organic and balanced diet. Residents are given a choice over whether to participate in the Anthrosophical or conventional care and medication, and generally have a combination of both. Residents are encouraged to participate in life in the local community and following their admission to the home staff will support them in orientating to the local area and accessing public transport. The standard of catering in the home is good with residents being offered choice at all meals. Staff are trained to support residents in their rehabilitation and also receive training in both the Anthrosophical way of life and the specific therapies. Staff are also trained in conventional methods of care, and are encouraged to train for a National Vocational Qualification in care and more specialised training including medication administration and diabetic care. Surveys received said: `We believe the home provides good care, and it is gratifying to see the level of care provided, in sometimes, difficult circumstances`. `I am very happy with the home They try to keep us updated and usually respond appropriately to concerns`. What has improved since the last inspection? Since the last inspection the garden has been landscaped and is accessible to all of the residents. Some redecoration has taken place, and in some areas there are new carpets. The range of activities and therapies on offer to residents has increased, and additions include : awareness and insight into brain injury (which is a ten session modular based course), `Weather and Observation` sessions, and exercise sessions which are run by a resident. The home is planning on providing internet access to all resident`s rooms. Staffing at the home is now stable with a full complement of staff now being employed. Residents are becoming involved in the formation of menus and the manager hopes to include them in staff interviews in the future. What the care home could do better: Care plans did not show evidence that some individual residents had been involved in the care planning process or had consented to the limitations put on their life style and requirements have been made around this. The positioning of call bells in the first floor bathroom requires addressing to ensure that residents are able to reach the call bells from both the bath and the toilet. A privacy curtain is required in the ground floor toilets. The manager must ensure that the home receives and confirms all references prior to staff being employed at the home and should ensure that the reports following visits by the provider (Regulation 26 reports) are in place. Not all issues raised at the inspection have been made the subject of a requirement due to the manager giving assurances that these issues would be addressed. These will be checked at the next inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Swanborough House Swanborough House Swanborough Drive Brighton East Sussex BN2 5PH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 1 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 34 Information about the care home Name of care home: Address: Swanborough House Swanborough Drive Swanborough House Brighton East Sussex BN2 5PH 01273696391 01273603208 marylove@raphaelmedicalcentre.co.uk 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) : Raphael Medical Centre Limited care home 31 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 31 The maximum number of service users to be accommodated is 31 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 admission to the home are within the following category: Physical disability (PD) Date of last inspection Brief description of the care home Swanborough House is registered to provide accommodation and personal care to 31 adults who have disabilities due to acquired brain injury. The home aims to provide a range of therapies and activities designed to promote rehabilitation. The registered provider is the Raphael Medical centre and the responsible individual is Gerhard Florschutz. The home follows the Rudolph Steiner philosophy of holistic living and all catering and therapies offered follow this philosophy. The homes literatures states that its vision is to develop and provide a residential rehabilitative unit and day care facility for adults with acquired brain injury, based on the Anthroposophic image of man as a being of body and spirit. The home is located in Brighton with access to local amenities, which include the Whitehawk community centre. Public transport routes serve the area. The home consists of single rooms, most of which have ensuite Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home facilities and there is a range of communal space, which includes a dining room, lounges and a large rear garden. Care Homes for Adults (18-65 years) Page 5 of 34 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: This key unannounced inspection took place on the 14th April 2009 over a period of eight hours, and was facilitated by the registered manager Mrs M Love. In this service, staff who provide care also assist residents with rehabilitation and are referred to as Rehabilitation Assistants, this will be the terminology used throughout the report. The inspector was assisted by an Expert by Experience and his supporter; Experts by Experience are people who have the personal experience of specific categories of service, either by directly having received care, or by working or having a relative receiving care from a similar service. Their experience of this enables them to assist at Care Homes for Adults (18-65 years) Page 6 of 34 inspections and to view the service from a different perspective to the inspector. They will be referred to as Expert or Expert by Experience throughout this report. On this occasion they talked to four residents and shared a meal with two others, using this time to observe staff working. They also talked with two members of staff to find out their experiences of working in the service. Other Methods used to collect information about the home included: examination of documentation in the home, a tour of the home and discussions with the manager. Staff work in two teams each team working part of the week over a twelve and a half hour day. On the day of the inspection one team was handing over information to the incoming team, and the inspector took the opportunity of sitting in on this handover, which was very useful in informing some of the judgements made in this report. Documentation examined included care plans, staff personnel, training and supervision records, catering records and health and safety files. Prior to the inspection, questionnaires were sent out to relatives, residents and staff. Of these four were returned from relatives and visitors to the home, eight from residents and five from staff members. These gave information about the daily life in the home and helped to inform the judgements made in this report. Thanks are extended to those people who responded. Surveys showed that generally people were pleased with the service they received, and discussions with residents showed that they received both the care they required and sufficient help from staff with rehabilitation and therapies. Residents said that they each have their own timetable for therapy and that staff support them in attending these. One resident said that staff supported him to shop for food and cook his food, whilst another stated that he had been able to go on holiday with staff support. Staff said that they received sufficient training and are encouraged to study for the National Vocational Qualification in care. The Annual Quality Assurance Assessment, required by regulation, which gives an overview of what has been achieved in the home and issues to be addressed, was received prior to the inspection. This accurately reflected the current status of the home and was used as part of the inspection process. Current fees charged range between One thousand one hundred and fifty pounds and one thousand six hundred pounds per week. The last key inspection took place on the 8th May 2007. The inspector extends thanks to the manager, Expert by Experience and supporter, residents and staff for their help, hospitality, and courtesy during the day of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 34 Care plans did not show evidence that some individual residents had been involved in the care planning process or had consented to the limitations put on their life style and requirements have been made around this. The positioning of call bells in the first floor bathroom requires addressing to ensure that residents are able to reach the call bells from both the bath and the toilet. A privacy curtain is required in the ground floor toilets. The manager must ensure that the home receives and confirms all references prior to staff being employed at the home and should ensure that the reports following visits by the provider (Regulation 26 reports) are in place. Not all issues raised at the inspection have been made the subject of a requirement due to the manager giving assurances that these issues would be addressed. These will be checked at the next inspection. 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 set out 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 34 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 34 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. The home provides sufficient information to enable prospective residents to decide whether the home will meet their needs and expectations. Prospective residents are assessed by the manager and a senior rehabilitation assistant prior to admission to ensure that the home has the facilities and expertise to meet the needs of the individual. Evidence: The home produces a Statement of Purpose and Service User Guide which comply with the National Minimum Standards and regulations, both these documents detail the rehabilitation therapies available. The manager gave assurances that all residents at Swanborough house have a copy of the Service User Guide. Surveys received showed that the majority of residents or their representatives felt that they had received sufficient information about the home, which assisted in them deciding whether the home could meet their needs. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Prospective residents are assessed by the manager and a senior rehabilitation assistant prior to admission, to ensure that the home can meet their needs and provide suitable rehabilitation facilities. Four preadmission assessments belonging to recently admitted residents were examined. These were very comprehensive and gave a substantial amount of information to inform the staff and to enable care plans to be commenced. The home encourages visits by prospective residents and their representatives. Following admission each resident receives a copy of the contract and terms and conditions of residence. The manager should ensure that the contracts specify the room number which the resident will occupy. The home admits residents for permanent and respite care. Care Homes for Adults (18-65 years) Page 12 of 34 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 encouraged to make choices about their lives and to fulfil their goals, however where limitations are required to be made regarding risks and behaviour there is not always written evidence of residents agreement. Evidence: Care plans address residents current and changing needs, with residents being supported to take risks within their daily lives. Residents take part in reviews of their care but only two of the four care plans examined had evidence that residents had been consulted or had agreed with the plan of care. There was insufficient evidence in daily records to substantiate that staff were helping residents work towards achieving their goals. There was evidence in the main body of the care plans that limitations on activities, behaviours and risks had been put in place ,but only one of the care plans showed evidence of the residents agreement to these. Staff spoken with, and the staff Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: handover, identified that staff were discussing these with the individual residents and getting verbal agreement, but this needs to be put in writing. Notifications sent to the Commission by the home have shown that residents are able to take risks, and that on occasions limitations have resulted, and been agreed with the resident. Each resident has a three monthly review where long and short term goals and care plans are reviewed. One survey received from staff stated that too much emphasis is put on the care needs of the residents, but insufficient emphasis on achieving goals. However during the past twelve months some residents have progressed to independent living outside of the home which shows that long term goals are being met. It was also evident at the staff handover that staff were aware of both the longterm and short term goals and methods were in place to help residents to achieve these. Residents participate in residents meetings which take place three weekly, any changes in the home are discussed at these and residents agreement gained, but residents do not otherwise participate in the running of the home. The manager has plans to include residents in staff interviews and residents can attend any of the staff training that they may be interested in, this is particularly relevant when staff are receiving training in acquired brain injury and one resident has attended this. The home keeps some money for residents for safe keeping but enables the residents to feel comfortable and able in handling their own money, and where this is not appropriate brings in advocates from the money advisory service. The home assists residents to open their own bank account and manage their money. The manager was able to show an audit trail of the residents money with relevant details and receipts in place. Confidentiality is one of the central themes in the home, underpinning all the care that is given, and staff were aware of the importance of this and receive the homes policies on this at induction and in ongoing training. Care Homes for Adults (18-65 years) Page 14 of 34 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 are encouraged to develop skills leading to an independent life style. The standard of catering is good with a varied diet and choices of menu available at all meals Evidence: Opportunities are provided for residents to gain life skills and enhance those they already have. Residents are encouraged to attend the various therapies available in the home, which can be held individually or as a group therapy and various therapists are employed in the home, including music therapists, art therapists and physiotherapists. The speech and language therapist from the NHS visits the home. Opportunities to gain skills in woodworking, cooking, and computer skills are offered; and there are various courses applicable to those who have suffered an acquired brain Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: injury, such as awareness and insight(a modular based course providing insight into acquired brain injury and its effects), concept skills, weather and observation ( awareness of the seasons and the daily weather) and gardening. An exercise class, run by one of the residents, is also offered. Staff enable people to go to church, orientate them to the surrounding area and take people on public transport, although the home has its own minibus. Several residents now have their own computers and there is internet access in the main computer room, but internet access in all the residents rooms is planned. Some residents are assisted to shop for and cook their own meals. One resident told the expert by experience that staff support them to do this. Whilst residents have a choice of what time they rise and retire, the various therapies and courses are on a timetable, necessitating the resident to motivate themselves. The expert by experience spoke with four residents, these residents said that problems encountered in previous years with therapists not being available, or staff not assisting them to therapies, is no longer happening. Residents said that they have their own timetable for activities and therapies and staff support them as much as possible to carry these out. The expert by experience also sat in with a group of residents who were participating in memory games and reading the current newspapers. Most residents progress to being able to take themselves out and into the local community during the evenings or the day time and make use of the local community centre. Residents are facilitated to maintain existing and new friendships and relationships and surveys from relatives stated that they were pleased with the care given and that they were kept informed of the residents progress and invited to attend reviews. Staff have also assisted residents to visit relatives or friends and have accompanied residents on holiday or on family visits. A recently landscaped garden provides opportunities for residents to do gardening and two residents are particularly interested in maintaining this. Some staff have learned sign language to enable them to converse with those residents who have a hearing impairment. Residents progress from living in the main area of the home, to the assisted flats in Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: the home, and from then on to supported living outside the home. The manager said that one resident is interested in working in the kitchen at the home and they are supporting them to gain the food hygiene course in order to do this. Residents have the opportunity to have a key to their room risk within the auspices of risk assessment. The expert by experience had lunch with the residents and observed staff assisting residents with meals in a discreet and empathetic manner. Whilst menus are now decided with the residents, they follow the Anthrosophical principles of varying the meals between fish, meat and vegetarian. The majority of the food used is organic and there is a choice of two options at each meal. Residents can have a cooked breakfast. One resident said that they never knew what they were getting for meals, but the manager said that all residents are asked what they would like at each meal. One resident was observed to come and order a meal different to the supper menu for that day and the catering staff were happy to comply with this. The kitchen was awarded five stars in the Environmental Health Scores on Doors Initiative Care Homes for Adults (18-65 years) Page 17 of 34 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. Staff are providing both rehabilitative and personal care and the staff handover showed that staff were aware of the individuals needs in both these areas, however this was not always evidenced in the care planning process. The standard of medication administration is improved and now fully safeguards the residents. Evidence: During the inspection four care plans were examined in detail, these belonged to both new and long term residents. New care plan formats have simplified the care planning process and made it more user friendly. However, there were some omissions in the care plan which make it difficult for the home to evidence that the appropriate care has been delivered and whether it has been delivered in a manner in line with the choices and expectations of the resident. Care plans need to be more detailed to explain in full how much support the individual needs with personal care and to provide clear directions to the rehabilitation staff on delivering this care. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Clear directives on the moving and handling of each individual needs to be put in place and daily records should identify what personal care or support was given on each day. For individuals who need support to get up and go to bed, preferred times were not designated in the care plan. There was no indication of specific night care plans and these should be commenced. Factors which trigger particular behaviours of individuals should be explicit in the care plans. As written in the previous section robust risk assessments for the use of bed rails and self administration of medication should be put in place. The pressures of electric pressure relieving mattresses must be monitored regularly and recorded, these pressures should be in line with the weight of the individual. Care plans have been reviewed regularly and amended as per the reviews. These are held three monthly with social workers the residents and any representatives according to the residents wishes. Staff must be ensure that residents sign their care plans to agree the initial plan and any changes made to this plan following reviews this also applies to the any changes made to limitations placed on the individual affecting daily life. Whilst it is recognised that the purpose of this home is primarily to provide rehabilitation, rehabilitation staff are also responsible for personal care to a number of residents. It is appreciated that this dual persona causes difficulties, insomuch as staff will tend to concentrate on writing on the dominant aspect of care. Senior rehabilitation assistants should ensure that the holistic aspect of care is recognised, and that they reinstate to staff the importance of the home being able to evidence that this takes place. Day staff work in two teams each working a specific number of days and a thorough handover is given to the incoming team. The inspector sat in on a handover and this was useful in that it provided substantial evidence that staff that staff were aware of the individual care each resident required, and the physiotherapist attending handover gave clear instructions regarding moving and handling needs verbally during the handover, and also demonstrated the technique required for a specific resident. This is the information that should also be evidenced in writing in the care plans. The handover also showed that General Practitioners were being accessed as required and working alongside the Anthrosophical doctors regarding treatment and medication and that district nurses, speech and language therapists, and other health care Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: professionals were being contacted as required. The handover detailed the resolving of a diabetic crisis by staff which occurred with a resident and evidence showed that this had been resolved correctly, giving testimony to staffs training in this by the NHS diabetic specialist nurse. Staff receive training at the Raphael Medical centre to apply liver compresses and other Anthrosophical treatment to residents. New medication practices are in place with residents now going to the clinic room to receive their medication, in some cases with support and prompting from staff. Staff take the medication trolley to the individual floors at night and administer medication from the trolley and if residents are going out for the day, medications are provided in dosset boxes. All medications had been signed for on administration and there was evidence of regular audit and good storage of medication. Eye drops, insulin, and liquid medication had the opening dates written on them. No controlled drugs are currently in use in the home. Staff receive training in the application of enemas and other invasive medication from the registered nurses at the Raphael medical centre to maintain accountability as does the NHS diabetic nurse for insulin administration. However it was noted that staff currently have no training in the administration of eye or ear drops. As this is included as an invasive medication this training must take place. The manager must ensure that following consultation between the General practitioner and the resident, the individuals wishes on resuscitation and preferred place of death is put in place in all care plans. Staff should have some end of life care training. Care Homes for Adults (18-65 years) Page 20 of 34 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 majority of residents are aware of how to make a complaint and are confident that their complaints will be dealt with in an open and transparent manner. Staff are aware of their responsibilities and roles in the safeguarding of those in their care. Evidence: The home has a complaints policy, which is displayed in the home and is included in the Service User Guide. Surveys received and residents spoken to, identified that residents were aware of how to make a complaint, although most stated that they would speak to a senior rehabilitation assistant or the manager, rather than go down the formal complaint route. In a home that provides care for residents with complex needs, it is accepted that the amount of complaints received will be above the amount normally expected for a care service. During the past twelve months forty two complaints were received by the home, of which two came to the Commission. Of these forty two complaints, thirty one were substantiated. The home holds clear records which showed that complaints had been addressed in an Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: open and transparent manner. During this time there have been three adult safeguarding incidents reported to the Commission, one of which was substantiated and dealt with by the manager, following recommendations from the adult safeguarding team. Staff have received training in the safeguarding of those in their care and those spoken with were sure of their roles and responsibilities. Care Homes for Adults (18-65 years) Page 22 of 34 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 adequate 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 and homely environment for residents. Concerns were raised regarding the site of the call bell in one bathroom, and the lack of privacy afforded to occupants of one toilet area. Evidence: The service aims to create a natural and homely environment, with a light and airy feel to the decor and enhanced with plants, in line with the Anthrosophical philosphy. Parts of the home are in need of minor redecoration and repair in order to ensure a consistently well maintained, decorated and safe environment throughout. The service now employs a maintenance person, which will be an advantage in ensuring that decorating and repairs are undertaken as needed. Communal space includes a dining room, various therapy and activity rooms, and lounges on each floor. A separate dining room is provided, and residents have access to a recently landscaped garden. During the past year some new furniture has been purchased for the ground floor lounge, but some residents said that the chairs were not as comfortable as the old Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: ones, however these have improved the look of the room. New chairs are needed in the upper lounges as these are showing a great deal of wear and tear, and also may be a barrier to robust infection control. A survey received stated that the writer had concerns about incidents which had occurred in the upstairs lounges, and thought that these may be due to lack of supervision by staff and suggested CCTV cameras. However this would impose on residents privacy, but the manager gave assurances that she would remind staff to supervise these lounges and ensure that call bells were within easy reach. A carpet in the corridor on the first floor presents a trip hazard, although new carpets have been provided in some areas in the home. Some of the bedlinen is worn and thin and requires replacement. The manager gave assurances that this would be done. Residents rooms are pleasantly decorated; with residents being encouraged to bring in their own possessions. Residents spoken with liked their rooms, and those who wish to do so can lock their doors, with keys being provided under the auspices of a risk assessment. Concerns were raised relating to the positioning of call bells in the upper bathroom, residents need to be able to reach the bell from both the bath and the toilet, and also regarding the lack of privacy in the male toilets on the ground floor, with a window in the one toilet which allows the occupant to be visible from outside. There is a wide range of individual aids and adaptations to assist residents mobility and independence. These include walking aids, variable height beds, grab rails, assisted baths, pressure relief mattresses and hoists. All areas inspected were found to be very clean and free from offensive odour. Care Homes for Adults (18-65 years) Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers with suitable training to meet the needs of the residents in the home. Some elements of recruitment procedures are not sufficiently robust to ensure residents are safeguarded. Evidence: The off duty rota confirmed that staff are employed in sufficient numbers to ensure that the needs of the residents are met. Two members of staff spoken with confirmed that there were generally sufficient staff to meet the needs of the residents and requests for extra staff were met. The home is now fully staffed and the turnover of staff is low. New staff undertake an induction course that incorporates the nationally recognised Skills for Care induction course and includes specific training on acquired brain injury. Training relating to Anthrosophical therapies and the background to this takes place both at the home, and the Raphael Medical Centre. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: Training records showed that staff receive ongoing training in adult safeguarding, health and safety, challenging behaviour and other aspects relevant to the care of the residents in the home. Mandatory training which includes moving and handling and fire training is ongoing. Senior staff have done some work relating to the Mental Capacity Act and it was evident that staff were aware of the implications of this. Staff speaking with the experts by experience said that they received Good training, which is based on Anthrosophical principles, to support the residents. However, it was noted that the chef had not received moving and handling and fire training until he had been employed for some months, and the manager must ensure that mandatory training and role specific training takes place within a reasonable time of commencement of employment. All grades of staff receive training on challenging behaviour and dealing with aggression, and whilst during a period last year, staff were feeling unsupported in dealing with this, staff now confirmed that they felt more supported and that management would address any aggression directed towards them. A staff survey received said that although there was mandatory training provided, training which could be used as professional development for professionals employed at the home was not regularly or easily arranged. Ten of the twenty five rehabilitation staff have attained the National Vocational Qualification level 2 or above in Care; and a further twelve members of staff are registered to study for this qualification. Four staff personnel files were examined. Whilst these generally confomed with regulation and contained the checks and references required by regulation, one member of staff had brought a reference with them and the home had not undertaken a confirmation of this, some staff also had personal references as opposed to professional references. These members of staff had previously been employed and therefore it is expected that professional references would be supplied. Staff receive copies of the General Social Care Code of Conduct and a staff handbook on commencing at the home. All rehabilitation assistants receive regular supervision and appraisal, and other staff Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: receive appraisal on an annual basis. Care Homes for Adults (18-65 years) Page 27 of 34 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. Management systems within the home support the staff and safeguard the residents and ensure the smooth running of the home. Evidence: The registered manager is sufficiently qualified, competent and experienced to run the home. She undertakes periodic training to meet professional and management responsibilities and has recently attended Deprivation of Liberty Safeguarding training and has arranged for some of the residents to be assessed in relation to this. The AQAA was received when we asked for it and contained relevant and comprehensive information. The home appeared calm but pleasantly busy, and residents and staff said that they were satisfied with the management approach, the atmosphere in the home, the level of training and opportunities and the care given to the residents. Surveys received showed that generally people were satisfied with the care and the rehabilitation offered Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: by the home: They try to keep us updated an usually respond appropriately to concerns. I am very happy with the home. If there were any reasons for complaint I would discuss these at the meetings I attend at the home and matters would be followed up and resolved. Food is of a high standard and my sons room is always kept clean. Quality monitoring is ongoing, and is attained by means of resident and relative satisfaction surveys, which are sent out every three to four months. Results are collated and these were seen at the inspection, there was evidence of an action plan to address any elements of dissatisfaction raised. Residents have meetings every three weeks and staff meetings take place once a month. Discussions are held with residents regarding menus, therapies and general running of the home during these meetings. The manager is in the process of reviewing policies and procedures in the home. Some of these policies are included in the staff handbook and staff have access to all policies, copies of which are kept in the staff offices. Records were generally up to date and there was evidence of regular servicing of equipment and utilities. Areas in which any perceived risks to residents or staff were found are dealt with in the relevant sections through the report. Systems are in place to ensure the financial viability of the home and business plans are in place, but these were not examined at this inspection. Public Liability insurance and other relevant insurances are in place. Whilst the manager states that the provider visits the home most weeks, there was no evidence of any Regulation 26 visits to the home since 23rd December 2008, which was the date of the last Reg 26 report . (Regulation 26 visits are visits and reports of these visits by the provider required by regulation) Requirements made at the last inspection have been complied with. The Commission receives reports of any incidents or accidents affecting residents. Care Homes for Adults (18-65 years) Page 29 of 34 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 30 of 34 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 6 12 That the home provides 30/05/2009 evidence that service users are consulted and agree to any limitations that may imposed upon them with regard to risks, behaviour or any other issue and provides evidence that service users are consulted about their plan of care. To demonstrate that service users are fully aware of any limitations on their daily lives and are in agreement with this and also with the care they are receiving. 2 18 15 That care plans and 30/05/2009 supporting documents are formed in consultation with the service user and there is evidence of involvement . That omissions in the care planning process as identified in the main body of the report are rectified in order to provide a full record of the care planned and Care Homes for Adults (18-65 years) Page 31 of 34 delivered and appropriate risk assessments are put in place. So that the service user is in no doubt as to the manner of care that is to be given and that staff are fully aware of the holisitic care to be delivered and any risks to the service users during the delivery of care. 3 20 13 That staff receive training in the administration of invasive medication such as ear drops and eye drops. To ensure the safety of the service users 4 34 19 That no member of staff is 15/05/2009 employed until references which have not been sent for by the home have been confirmed. That references obtained are from previous employers or persons who known the applicant in a professional capacity whenever the curriculum vitae shows evidence of previous employment To safeguard the service users. 5 43 26 That the provider visits the home and provides monthly reports in line with the requirements of the regulation It is the providers responsibility to ensure that 29/05/2009 30/06/2009 Care Homes for Adults (18-65 years) Page 32 of 34 the running of the home safeguards service users and 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 21 That staff receive training in end of life care. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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