Care Home: The Annexe

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What the care home does well The Home is well managed in a way which puts the needs of the clients first. The staff support clients to live their lives in a way which respects their individual preferences and choices. The staff are enthusiastic about working with the clients and have a good understanding of individuals needs and how these should be met. The staff are respectful about the clients and we observed positive communication between staff and clients. What has improved since the last inspection? The clients are being supported in a much more individualised way and the staffing is provided to do this. Clients are supported to take part in a greater variety of activities, both in the local community and at Home. Transport is provided to enable this to happen. The care plans and risk assessments are much more detailed and contain better guidance for staff about how to meet individuals needs. The clients are encouraged to be part of this process and to take part in reviews.The views of the clients are sought on a more regular basis, both informally and more formally at regular 1:1 time with staff. Training and support to the staff team has improved. The staff said that they are offered more opportunities to attend training that is relevant to the needs of the clients living at the Home. This has included training about diabetes, dementia, supporting people with challenging behaviours, mental capacity act. Regular staff meetings and staff supervision is taking place. Recruitment has taken place so there is less agency staff working at the Home. The deputy manager is now responsible for the day to day management of this Home which means that there is clearer leadership and more ongoing support for the staff team. What the care home could do better: There is a need for clearer information within the care plans about the arrangements in place for looking after the clients money. There is also a need to provide relevant information in simpler formats which would make it easier for the clients to understand. CARE HOME ADULTS 18-65 The Annexe 161 Wootton Road Kings Lynn Norfolk PE30 4BU Lead Inspector Lella Hudson Unannounced Inspection 9th September 2008 10:00 The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Annexe Address 161 Wootton Road Kings Lynn Norfolk PE30 4BU 01553 673194 01553 674395 onesixone@bt.openworld.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) One-Six-One Limited Sharon Jones Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 people, of either sex, with a Learning Disability, may be accommodated. 24th September 2007 Date of last inspection Brief Description of the Service: The Annexe is a care home providing care to three people with learning disabilities. It is situated within the grounds of One-Six-One another residential care home owned by the same organisation. The Annexe is in a residential area of Kings Lynn, within approximately a mile of the town centre. There are local shops, library and other amenities within the immediate vicinity of the home. The premises consist of accommodation on two floors accessed by the stairs. There is a lounge, kitchen, dining area, utility area, bathroom and one bedroom on the ground floor. Two further bedrooms are located on the first floor in addition to the staff sleep-in room. There is also a patio and garden area. The home provides care for ambulant people who may require consistent support for their behavioural needs. The fees range for current service users from £1263 to £1903. The Home is owned and managed by CareTech trading as One-Six-One Ltd. The Manager, Sharon Jones, was registered by the Commission in May 2008. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is TWO STAR. This means that the people who use this service experience GOOD quality outcomes. This report contains information gathered about the Home since the last Key Inspection in September 2007. It also includes information provided by the Home in the form of notifications and information about concerns/complaints/allegations. The Manager completed and returned the Annual Quality Assurance Assessment (AQAA) which contains a lot of information about the Home. The organisation also owns and manages an eight bedded Home (OneSixOne) which is situated in front of this Home. The site is now known as The Mallards. Both Homes are managed and staffed by the same staff team. Both of the Homes were inspected at the same time although each Home has its own Inspection Report as they are registered separately. There are currently two clients living at the Home and therefore there is one vacancy. What the service does well: What has improved since the last inspection? The clients are being supported in a much more individualised way and the staffing is provided to do this. Clients are supported to take part in a greater variety of activities, both in the local community and at Home. Transport is provided to enable this to happen. The care plans and risk assessments are much more detailed and contain better guidance for staff about how to meet individuals needs. The clients are encouraged to be part of this process and to take part in reviews. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 6 The views of the clients are sought on a more regular basis, both informally and more formally at regular 1:1 time with staff. Training and support to the staff team has improved. The staff said that they are offered more opportunities to attend training that is relevant to the needs of the clients living at the Home. This has included training about diabetes, dementia, supporting people with challenging behaviours, mental capacity act. Regular staff meetings and staff supervision is taking place. Recruitment has taken place so there is less agency staff working at the Home. The deputy manager is now responsible for the day to day management of this Home which means that there is clearer leadership and more ongoing support for the staff team. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place to ensure that effective assessments are carried out prior to a client moving into the Home. EVIDENCE: The Home currently has a vacancy. The Manager described the process that would take place following an enquiry about a vacancy. The organisation has procedures relating to the admission of clients and these include obtaining the views of the client and of ensuring that they were invited to visit the Home prior to moving there. The Manager is aware of the importance of ensuring that the Home can meet the needs of any prospective clients. The previous requirement about the need to update the Statement of Purpose for the Home has been met. Another document called ‘Welcome to The Mallards’ has been produced and the Manager is aware that a couple of minor alterations are needed to ensure that this is completely accurate and up to date. The Manager said that they are reviewing how this information can be provided in a way which clients may find easier to understand. We saw one of the clients contracts. This contains the majority of the information about what is covered within the clients fees but does not contain information about costs for transport. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 9 The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care plans provide clear guidance for staff about how to meet the clients needs. EVIDENCE: We looked at one of the care plans and risk assessments. These have been improved since our last visit to the Home and are now more personalised and individual to each client. The format of the care plan has been changed so that the most relevant information relating to individuals care is now kept in a smaller file which is more accessible. The other information, which is not necessarily needed on a daily basis, is still easily accessible to staff. The care plans contain assessments, risk assessments and detailed guidance about how to meet individuals needs. The care plan that we saw contains information about a range of needs, including health and personal care, behavioural support, social and emotional support. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 11 Risks are recognised by staff and clear guidance is in place for staff to be able to manage risks effectively. The records that we saw show that the rights of the clients to make choices is considered alongside the risks to themselves or others. Where restrictions are in place these are clearly recorded, as well as the reasons for this. Staff who spoke to us said that they regularly read the care plans and are involved in reviewing and updating them. Minutes of the staff meetings indicate that the individual care needs of the clients are regularly reviewed and discussed. The organisation has introduced ‘Talk Time’ sessions which means that staff spend 1:1 time with each client as a way of trying to find out their views about a range of issues. The clients have communication difficulties and so it can be hard for the staff to obtain a real sense of the clients views. The more consistent staff group and the increased training help the staff with understanding the needs of the clients. There is evidence that the care plans are regularly reviewed and that information and guidance provided by health and social care professionals is incorporated into them. There is also evidence that the clients are encouraged to be involved in the care planning process. The staff complete daily records which includes information relating to the individuals care plans. The care plans do not contain detailed information about the arrangements in place to look after clients money. The Manager explained the system that is in use but is not clear about how much money each client is entitled to each week. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, ,13, 14,, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The clients are supported to take part in a range of activities that are meaningful to them. The clients are encouraged to be involved in planning menus, shopping and cooking. EVIDENCE: There have been improvements in the quality and quantity of activities that the clients are involved in. The AQAA included information about a range of activities that clients are supported to access and discussions with staff confirmed that these take place. There are currently two clients living at the Home. Neither of the clients attend any kind of formal day service. The current staffing levels mean that there is 1:1 support for each client at present. This enables them to be supported to take part in activities in the Home and in the community on an individualised basis . The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 13 The Home is located close to the town of Kings Lynn and the clients either walk to local facilities, use the bus or use one of the three vehicles that are available for the clients living at the main house and in the Annexe. The care plans include information about how individual clients like to spend their time and also the arrangements in place to enable them to maintain contact with relatives and friends. The Home no longer has a dedicated cook and so all of the care staff are involved in planning menus and preparing meals. Staff said that there are no set times for mealtimes and that meals take place at times that suit the clients and whatever activities they are involved in. Staff encourage the clients to be involved in choosing menus through the use of photographs of meals. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of the clients are met, this includes the safe administration of medication. EVIDENCE: The care plans contain detailed information about the personal and healthcare needs of the clients. It also includes information about how the individual clients prefer to receive their care. Discussions with staff showed that staff are aware of the individuals needs and gave consistent answers to questions about how care is provided to particular clients. Information in the care plans show that clients are supported to have regular appointments with the dentist, optician and chiropodist as required. There has also been increased involvement of other health/social care professionals as clients needs have changed. Staff have recognised when clients need the support from other professionals and have made appropriate referrals. They have also worked hard to support clients when they find situations difficult. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 15 Discussions with staff provided evidence that staff are now receiving training in a more timely way about issues relating to individuals needs. For example, the staff have received training with regard to supporting clients with difficult behaviours, including the use of restraint as well as training about diabetes, epilepsy and the mental capacity act. Staff are clear about the importance of good communication and understanding the function of behaviour when supporting clients whose behaviour can be challenging. The Home has started to use the Health Action Plans which are recommended to be used for people with a learning disability. This document contains all relevant information relating to clients physical and emotional health needs and is easily updated. This is in addition to the information being contained within the care plans. The medication system was seen and evidence provided to show that the requirement made at the last Inspection has been met. Medication is stored appropriately and records are kept of the receipt, administration and disposal of medication. There is a communication book kept by the medication cupboard which is used to record any changes in medication. Staff are not able to administer medication until they have received appropriate training. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The organisation deals appropriately with complaints and staff receive training with regard to protecting the clients from abuse. EVIDENCE: The complaints procedure has been put into a simpler format which the clients may find easier to understand. We have not received any complaints about the service and the Manager said that they have not either. The staff receive training with regard to Safeguarding vulnerable adults and also other relevant training such as working with people with challenging behaviours. Staff who spoke to us were very clear that the use of restraint is only ever used as a last resort and they were able to give consistent answers to questions about the possible triggers to individuals behaviours and how to respond to these. The Manager has made two referrals to the Safeguarding team since the last Inspection. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home provides quite bare and functional accommodation EVIDENCE: The Home has an ongoing maintenance and redecoration plan. Since the last Inspection some areas of the Home have been redecorated. The stair carpet is in need of replacement and the most recent monthly visit report by the organisation has already identified this. The communal areas of the Home are fairly bare and functional. The staff said that this is because the clients break or knock down ornaments and pictures. However, the deputy manager said that they are in the process of trying different ways of safely putting pictures and ornaments around the Home. The clients are encouraged to personalise their own bedrooms and to be involved in keeping them clean/tidy. The clients have access to all areas of the Home apart from each others bedrooms. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 18 On the day of our visit the Home was clean and there were no unpleasant odours. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The clients are supported by an effective staff team who receive appropriate training and support. Appropriate recruitment procedures are followed. EVIDENCE: The staff who spoke to us said that the training opportunities and the support provided to the staff team has increased since the last Inspection. Staff said that they are supported to attend training in subjects relevant to individual clients needs as well as to complete NVQs. One of the staff spoke highly of the induction that she has recently undertaken and said that she has received good training and ongoing support from other staff. Staff said that staff meetings take place on a regular basis and that the Manager is always available to discuss issues with as well as providing formal supervision sessions. The staff confirmed that less agency staff are used now and that recruitment has meant that the staff team is more stable and consistent. They said that the staff morale has improved and that communication amongst the staff team is good. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 20 We looked at the staff rotas and these confirm the information gathered from staff and the Manager about the staffing levels provided. The deputy manager has recently started to work solely at this Home rather than at both Homes and is taking a much more active role in the management of this Home. The deputy manager is mainly working as the second person on duty but does have some additional time when she can carry out management tasks. The Manager is aware of the importance of ensuring that staffing levels are adequate when a new client is admitted to the Home. We looked at a selection of recruitment files and could see that appropriate checks are carried out prior to a member of staff starting work at the Home. One of the staff confirmed that this took place before she was offered a job. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Clients benefit from living in a Home which is well managed and which is run around the needs of the clients. Procedures are in place to ensure that the health and safety of the clients and staff is protected. EVIDENCE: The Manager has completed the registration process with the Commission since the last Inspection. She has suitable experience and skills to manage the Home. Staff who spoke to us said that they receive good support from the Manager and that she is approachable. The deputy manager has taken on the role of managing this Home on a day to day basis. This is an improvement as it provides a more consistent management style for the staff and clients. It has also meant that staff can be better supervised and supported. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 22 The improvements that have been made since the last Inspection are in relation to ensuring that the clients are viewed as individuals and that their needs are met in ways which respect their choices and preferences. There are a range of ways in which the views of the clients are sought although this can be difficult due to the communication difficulties that the clients have. We had discussions with the Manager about the use of questionnaires as a tool for obtaining others views of the service and of the need to bring all of the quality assurance information together into an annual report. We looked at a selection of records relating to health and safety and could see that regular maintenance and servicing of equipment, including fire safety equipment, takes place and that staff receive appropriate training. A full fire alarm system has been fitted at the Home since the last Inspection rather than the smoke detectors that were previously in place. The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 17 (2) Schedule 4 Requirement A financial care plan must be kept for each client to ensure that there is clear information about what money the client is entitled to and how this is managed on their behalf The stair carpet must be replaced to ensure that it is in a reasonable condition Timescale for action 31/10/08 2 YA24 23 (2)(b) 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Annexe DS0000027605.V371345.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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