Care Home: Taverham Road (21)

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What the care home does well There has not been any changes with the admission procedure since the last inspection both residents have lived at the home since it opened. The written details regarding the service gives any prospective residents clear guidelines about what to expect before moving in. It was clear that residents are involved in planning their care and that risks are safely managed. It was observed that residents make their own choices in respect of meals occupation, activities and that staff treat them with respect and dignity building a good rapport with each other. The home is comfortably furnished and decorated and staff are supportive and kind to the residents. Any complaints are listened to and acted upon immediately. What has improved since the last inspection? There were three requirements issued at the last inspection. The guide to the service has been improved into a more accessible format for people who may wish to live at the home. The quality assurance survey includes confidential consultation with people living at the home resulting in any issues being discussed during the residents meetings. The water temperatures are regularly checked to reduce the risk from scalding. The recommendations issued at the last inspection have also been adapted to ensure good practice. This includes a policy for staff intervention, PRN medication, an audit of complaints to identify any trends, with a manual of key policies for agency staff to access. What the care home could do better: At present there are staff shortages and a high use of agency staff, it appears common practice for the manager to be included on the duty rota reducing managerial arrangements to cover all three services under his jurisdiction. There is a low number of permanent staff achieving the recommended National Vocational Qualification in care. The car that is provided for transporting the residents has broken down recently and left residents in a vulnerable situation and this should be remedied. The care plans although, provides good information is repetitive and could be condensed to make them easier to read. The carpet in the dining area is rather stained and should be replaced. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Taverham Road (21) New Boundaries Community Services Ltd 21, Taverham Road Norwich Norfolk NR10 4DR     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: Hilda Stephenson     Date: 0 2 0 6 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 28 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 28 Information about the care home Name of care home: Address: Taverham Road (21) 21, Taverham Road New Boundaries Community Services Ltd Norwich Norfolk NR10 4DR 01603754915 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) : bobj@newboundariesgroup.co.uk New Boundaries Community Services Ltd care home 2 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 2 The maximum number of service users who can be accommodated is: 2 The registered person may provide the following category/ies of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home 21 Taverham Rd provides accommodation for two adults with learning disabilities. It is a detached bungalow with parking to the front and a garden to the rear. Accommodation comprises two bedrooms, a shower room and toilet, a kitchen, lounge/dining room and an office which doubles as a sleep over room for staff. The home is situated on a main road in the village. The village itself has a pub, village hall and some shops and private businesses. There are limited public transport services in the area. The range of monthly fees is #1,600 - #2,800. Care Homes for Adults (18-65 years) Page 4 of 28 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: Care services are judged against outcome groups, which assess how well the provider delivers outcomes for people using the service. The unannounced key inspection of this service has been carried out by using information from previous inspections, written information provided by the manager, some residents and others who work in or visit the home. This unannounced visit took place during the day of Tuesday 2nd June 2009. The manager and senior support worker was in attendance during the afternoon and early evening. Prior to the inspection the manager provided a completed Annual Quality Assurance Assessment (AQAA) giving details of what the homes strengths and weaknesses were and how these could be adapted to improve care for residents who Care Homes for Adults (18-65 years) Page 5 of 28 live there. During this visit a tour of the premises was undertaken, staff practice was observed and staff files and care records were read. Both residents were consulted about their experience of the service with one showing the Inspector there private room. 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 set out on page 4. Care Homes for Adults (18-65 years) Page 7 of 28 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 28 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 28 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 have their needs assessed prior to moving into the home, have access to written details about the service and contracts drawn up in line with their care provided. Evidence: There have been some improvements in the written information that is provided to prospective residents. Although there have been no change of residents since the last inspection the manager explained the admission process. The records of the people living at the home were read and found to contain details about them before they moved into the home, following clear guidelines of the companies admission procedure. Pre-admission details were recorded with follow up visits and short stays at the home before moving in permanently to ensure the residents smooth transition. The contracts contained details of the fees and any extra payments required to stay. The minimum and maximum fees remaining between £1,600-£2,800 a month. The statement of purpose and homes own guide will need to change the name of the Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: manager when he becomes registered with the Commission. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are consulted about the level of care and support they need. Evidence: The care plans were read through of both of the residents. These were up to date and provided the required information for the support staff to look after them appropriately. The records were contained within two files for each resident and some of the information was repetitive within the same file. This may be easier and more user friendly if all the information was contained within the one file for each person. Both of the residents confirmed that they are consulted about their choices throughout the day and this was observed during the day of the visit. The care plans demonstrated that the risk assessments were beneficial for the residents to continue to live the lifestyle they wished to continually being supportive by staff. One of the residents continued with a one to one supportive level of care. Each Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: resident has a key worker they meet with each week to plan the following day or weeks social activities to ensure that adequate numbers of staff are on duty. The key worker and manager compile the care plan with the resident to ensure they are fully informed about their care and an agreement is reached that both parties follow. Care Homes for Adults (18-65 years) Page 13 of 28 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 choose how they follow a structured working week including social and educational needs to maintain and develop their life skills. Evidence: Both residents were keen to explain what they did during their week and confirmed that they have a structured programme that they follow, mainly from Monday to Friday. One enjoys attending the day centre and college, with the second resident enjoying working outdoors, using his skills to maintain the garden at the bungalow as well. Both residents confirmed that they found their chosen occupations satisfying. Each resident spoke about how they spend there free time, with each enjoying very different activities. One enjoyed going to play bingo, swimming and drives to view the countryside. Another enjoyed walking, playing snooker and gardening. Both confirmed Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: that they regularly visit and stay with their families, although one mentioned the car had broken down twice on his last journey to see them, and that this had made the journey considerably longer. Due to the company providing transport for each of their homes, the car should be maintained to a high standard to reduce any risk of residents being put in this predicament in the future. The manager explained that both residents keep in regular contact with their friends and family. The staff and residents confirmed that they are all involved in the planning of the meals, shopping and preparation of the meals, and had there own cupboards within the kitchen for their own preferences for breakfast and snacks. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to continue to have their health care and personal needs monitored. Evidence: Evidence of medication training for staff who administers these were seen within the staff files. Medication is safely stored and appropriately administered. The senior support worker demonstrated the medication and the records were checked and in good order. Both residents confirmed that they are treated with respect by the staff and that they are helped with their daily routines when required. When checking the care plans these showed that the residents continually meet up with their own health care professionals and attend hospital appointments when these are arranged. Care Homes for Adults (18-65 years) Page 16 of 28 Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are able to express their concerns and are protected from abuse. Evidence: The service has had one complaint investigated via the Adult Protection Team and was found to be unsubstantiated. The residents spoke about how they complain and were both satisfied that any complaint or concerns were acted on immediately. The complaints book was read showing that the manager and staff team act upon these to improve standards for the residents. The manager explained that the staff had received training on adult protection and the staff on duty confirmed they knew about the policies covering adult protection issues. Care Homes for Adults (18-65 years) Page 18 of 28 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 bungalow offers a clean, comfortable and homely environment for people to live an independent lifestyle. Evidence: The Inspector was accompanied round the two bedroom bungalow which consists of a lounge combined dining room with a connecting small office. The kitchen contained cupboards for residents to store their own food supply, washing machine, fridge and cooker. There was a separate staff toilet. Both residents have en suite facilities within there rooms with a shower room situated next to the bedrooms. Residents tend to do their own washing and keeping their own rooms tidy as they would if they were living at home. Support staff ensure that adequate supplies of cleaning ingredients are in place. Outside there is a smoking area with table and chairs for residents to sit out and this is used for alfresco meals and barbecues. One of the residents explained that they look after the garden by regularly mowing the lawn and tending to some of the pot plants situated round the area. The garden consists of a greenhouse, although their is no door on this, the resident said they Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: would have liked to have grown some tomatoes. The Inspector was invited to view one of the residents rooms which contained items that reflect their personal taste, including family pictures and own bedlinen. The manager stated that both the bedrooms were in line to be redecorated and had consulted the residents for their choice of colour scheme. The carpet in the communal area was rather grubby and would need replacing in the near future, the manager said that this was already in place, they had decided to replace the dining area with a washable flooring. Care Homes for Adults (18-65 years) Page 20 of 28 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. People living at the home are not offered consistency with the staff team and the use of agency staff must be reduced. Permanent staff are well trained and skilled to carry out their roles, although need to include the recommended vocational training. Evidence: The home has two permanent staff and the manager who is currently undergoing the registration to support the residents. Staff from other homes and the same agency staff are used to make up the team, although this does not show consistency for the residents. The manager stated that the company had recruited support staff but unfortunately, they had not remained, so the manager was recruiting again. The company follow a clear recruitment procedure checking potential staff references, crb before they commence working with vulnerable people. All new support staff follow an induction programme and are supervised during the first weeks of employment. Reading through staff files they showed the permanent staff had undergone the following training courses during the last year which were on epilepsy, mental health capacity act, non violent physical intervention, de-escalation, autism, first aid in choking and medication. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: During the day of inspection the duty rota showed that there were always two support staff on duty, and sometimes this was the manager. This could prove difficult if he is called out to one of the other homes he manages as it would leave the home short of staff on occasions and safety of residents could be at risk. The number of staff having the recommended National Vocational Qualification is low and this needs to be addressed. While speaking with staff they confirmed that they receive regular supervision with the manager and felt this was beneficial to them. Care Homes for Adults (18-65 years) Page 22 of 28 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 home is managed in an open and inclusive manner. Evidence: There has been a change of manager since the last inspection. The current manager, James Vasco is undergoing the registration process and manages two other small services. He is included on the duty rota due to the home being short of permanent staff and this reduces his management hours which is not ideal and should not continue for any length of time. He is currently doing the Leadership and Management training and his Assessor was present at the time of this visit. He has worked within the Learning Disability area for a number of years as a senior support worker and this is his first managerial role. He is supported by the Operational Manager who was also in attendance for part of the inspection, and offers support and supervision to him. The last quality assurance survey was seen showing that the staff team had taken into account the comments that had been returned and these had been discussed with the residents on how these issues could be developed. Evidence of regular staff and Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: residents meetings and the Regulation 26 records were also in place and read. The manager keeps some money safe for both residents and these records were checked and found to be in good order. A sample of the required maintenance records for fire, water temperature, safe keeping of chemicals, boiler maintenance, management of accidents and security of the building were checked and found to comply with the standards. The current insurance certificate was in date and displayed, although the registration certificate needed to be replaced when the manager becomes fully registered. Overall, the home is run in a way to ensure the health and safety of both residents and staff are in place. Care Homes for Adults (18-65 years) Page 24 of 28 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 25 of 28 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 15 13 The transport supplied by the home must be in good order to eliminate risk to resident of breaking down and causing undue stress when visiting relatives. . 02/09/2009 2 33 18 The manager should not be working as part of the support team in case he is called away to his other homes leaving the residents short of staff. The residents may be at risk if the manager is called away while he is on duty. 02/09/2009 3 33 18 The residents must have a permanent core staff team to support them. The home still uses a team of agency staff which does not reflect the permanence of the staff team. 02/09/2009 Care Homes for Adults (18-65 years) Page 26 of 28 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 1 The managers details will need to be added to the statement of purpose when the registration process has been complete. The information of residents care needs are separated into two files and to make this easier for care staff and residents to read should be contained in one file and may need to be condensed to reduce the repetiveness of the information. The home has low numbers of staff having achieved the relevant NVQ training and this should be addressed to bring it in line with the recommended fifty per cent. 2 6 3 35 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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