Care Home: The Duke's House

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What the care home does well 67 Wellington Road has constantly reviewed its practice since it was registered and it is always striving to improve the service offered to the people either living in the home or to prospective clients. The service is flexible and reflective and the home`s management team have looked at where they are now and where they want to be in the future. This helps to ensure that the home is able to respond to changing needs, which in turn enables people to maintain as much independence as possible. There is a strong commitment from everyone working at the home that helps to ensure that the quality of care is provided to a high standard. People are treated with respect and dignity. One of the staff members spoken with said "I love coming to work". We found that staff members were able to demonstrate an awareness of the diverse needs of the people they were caring for and wanted them to have as good a quality of life as possible. Positive and warm relationships were seen to exist between clients and staff members. A good choice of meals are available for people to eat. Fully accessible and very well maintained gardens are available for clients and their families to use. The quality of record keeping within the home is being maintained to a good standard; this helps to ensure that people`s needs are identified and addressed quickly. What has improved since the last inspection? This is the first inspection since the home was registered in April 2009. What the care home could do better: As this is a newly registered service and this is its first inspection without a proven track record we are unable to give it an excellent rating. We consider that 67 Wellington Road is a very good service so rather than state what they could improve we would expect that the home continues to review its practice in order to ensure that the good standards provided at the present time are maintained and where possible improved upon. There is no reason why it cannot be rated as a 3 star excellent service at the next inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: The Dukes House 67 Wellington Road Wallasey Merseyside CH45 2NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Paul Ramsden     Date: 2 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Dukes House 67 Wellington Road Wallasey Merseyside CH45 2NE 01244651961 01244651969 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Inclusive Lifestyle Ltd Name of registered manager (if applicable) Mrs Kim Jones Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category 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. The maximum number of service users who can be accommodated is: 4. Date of last inspection Brief description of the care home 67 Wellington Road is a three storey care home that is owned and managed by Inclusive Lifestyles Ltd; a company which specialises in providing highly personalised care to people with learning disabilities. The home is located very close to the New Brighton Promenade and is a short walk to the local shops, public transport and a theatre. The home opened in April 2009 and provides accommodation to four young adults. Clients are accommodated on the ground and first floors only, the second floor has offices and training facilities. There are four bedrooms all with en-suite facilities. There are a variety of communal facilities available, these include lounge and dining rooms. Aids to help maintain independence are in evidence throughout the Care Homes for Adults (18-65 years) Page 4 of 26 4 Over 65 0 Brief description of the care home home; these include bathing aids and night sensors that alert the night staff members via a pager if someone needs assistance. There is a well-kept and easily accessible garden for the clients to use. Information regarding fees are available from the home manager. A copy of this inspection report can be made available upon request from the home or via the Care Quality Commissions website.. Care Homes for Adults (18-65 years) Page 5 of 26 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 unannounced visit took place on the 25 September 2009 and lasted for approximately six hours. Paul Ramsden, Inspector, undertook the visit on behalf of the Care Quality Commission [the replacement body for the Commission for Social Care Inspection, CSCI, since 1 April 2009]. Any references to we or us in the report refer to the Commission. All of the key standards for young adults were looked at. Feedback on the findings of the inspection was given to the managing director of Inclusive Lifestyles Ltd as the inspection progressed and in a phone call to the home manager after the visit had ended. This visit was just one part of the inspection. Prior to the visit the home manager was asked to complete an Annual Quality Assurance Assessment [AQAA] to provide up to date information about the service provided in the home. This is a very detailed questionnaire that provides us with a lot of information about the service before the visit. Care Homes for Adults (18-65 years) Page 6 of 26 During the visit various records and the premises were looked at. When looking at the documents relating to the type of care each person needs [assessments and care plans]we use a system called case tracking. This is a method that allows us to follow or track a particular situation in order to ensure it was dealt with appropriately. A number of clients and members of staff were spoken with; they gave their views about the home and the service provided. Some of these comments have been quoted in the report. Although the commission has registered the service as 67 Wellington Road it is referred to by the company and staff members as the Dukes House; this name also appears on the documents such as the service user guide. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 26 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. Information and opportunities to visit are available and clients are assessed before moving in to ensure their needs can be met at the home. Evidence: The home has a statement of purpose and service user guide [called Your Service document] available. This is given to all of the people living in the home; it contains information about the facilities, services provided, fees, complaints procedure and advice about advocacy services. This document is provided in an easy read pictorial format and is very well written. The service document contains all of the information required by us and we think that it should provide sufficient information for anybody who is thinking of moving into the home. Prospective clients would be encouraged to visit the home with their representative, view the premises and chat to other residents and staff. A thorough assessment demonstrating that the clients individual needs could be met by the home had been undertaken prior to admission for the the people whose files were looked at. The manager or a member of the senior staff team with a Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: considerable amount of input from the prospective client [where possible] and family members/social workers undertake the assessments. This assessment can be done in a persons own home, another care home or hospital. This provides an opportunity to make sure the home can accommodate the person and their individual needs. Everyone currently living in the home are funded by the Local Authority who also provide an assessment of the persons needs prior to admission. This provides background information as to the reasons why a move to the home is needed and is very useful when combined with the homes own assessment. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person centred plans seen were very well maintained and provided all of the information needed for staff members to be able to take appropriate action to meet an individuals needs. Evidence: The personal support plans [care plans] seen were all up to date and provided staff members with all of the necessary information for them to look after a persons needs. The plans seen were individualised and demonstrated that the service tries to improve the outcomes for the people living in the home. The health and well being of clients was being monitored and an appropriate record of actions being taken was kept. The plans are an up to date working tool and we saw that they were being reviewed and where necessary amended and re-written on a regular basis. Those seen were very well documented and provided a comprehensive amount of information about the individual concerned. Staff members are expected to sign that they have read and understood the plans; this was confirmed by them Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: during the visit. There is also a comprehensive risk assessment undertaken; this is also reviewed regularly. The service has a can do attitude and risks are managed positively to help people lead as fulfilling a life as possible. The client spoken with during the visit told us that they liked living at Wellington Road and that they were happy being there. We saw that the standards of care provided were very good and that the people using the service were being treated with courtesy, respect and good humour by staff. They were seen to be interacting with individuals in an appropriate way, knocking on bedroom doors before entering and addressing people according to their wishes. Care Homes for Adults (18-65 years) Page 13 of 26 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. Clients using the service are able to maintain contact with family and friends and those spoken with were positive about the home and the support they received. Evidence: On the day of the inspection we saw clients going out and there were a variety of opportunities for them to become involved in community activities and events; these include, visits to the pub and shopping trips. There is transport available for people to use and each of the person centred plans included information on individual likes and dislikes. This is a new service and some of the clients living in the home have only been there for a relatively short time; as a consequence the AQAA states, we need to explore further local, and further afield, opportunities for education, community involvement, and work/volunteer experience. People have built up their own personal networks of friends and relatives either within Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: or external to the home. We saw examples demonstrating that clients had a variety of hobbies and interests that they enjoyed. Clients were able to move freely around the home and a choice of sitting areas was available. Routines within the home were flexible and people are able to make choices in many areas of daily living; for example, times of rising and retiring, whether or not to join in with planned activities and where to spend time and with whom. The staff members spoken with had a very positive attitude towards the people they were supporting and obviously wanted the best for them. Meals can be eaten in the main dining room or in the privacy of a persons own room. The menu is flexible and can meet an individuals needs and choices. Special diets can be provided if needed; these would be discussed upon admission. The kitchen area was seen to be clean and well organised. Care Homes for Adults (18-65 years) Page 15 of 26 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. The clients are encouraged and supported to have as much independence as possible. Evidence: Clients are enabled to live their lives an independently as possible. Staff members do this by respecting privacy and offering choices. Personal care, if required is provided in private and takes into account an individuals preferences and needs. Staff members spoken with could show that they had a good understanding of the people they were supporting and they were able to meet their diverse needs. The changing needs of individuals are discussed as and when required. We were able to see this in practice during the visit when information about individual clients was passed to the staff members who were changing shifts. Support staff work to a very good standard in order to ensure that the clients receive the care they need. They monitor health and emotional needs daily and there was evidence to show that people were receiving the appropriate support from district nurses, GPs etc. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: Policies and procedures in relation to medication are in place. Medicines are administered using a blister pack system provided by a local pharmacist. The arrangements for the administration of medicines were looked at during this visit; no major issues were seen and clients were being given their medication as prescribed. Care Homes for Adults (18-65 years) Page 17 of 26 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. Clients and relatives/other parties are able to complain/make suggestions and action would be taken to respond to their concerns. Adult protection training for staff is available to ensure the continued safety of the clients receiving a service. Evidence: There is a clear and effective complaints procedure for the home; this is included in the statement of purpose and the Your Servicedocument. No complaints have been made since the home opened; we have not received any. The home has a safeguarding procedure that complies with all of the relevant legislation and good practice guidelines. This is designed to ensure that any possible problems that arise are dealt with openly and people are protected from possible harm. All staff members undertake training in this area. We have not received any issues regarding safeguarding. Care Homes for Adults (18-65 years) Page 18 of 26 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 facilities and accommodation provide clients with a comfortable and homely place to live. Evidence: A tour of the premises was undertaken; this included communal [lounges/dining room]areas and a number of bedrooms. These were seen to be personalised and contained many personal items. The building is being well maintained and no obvious issues requiring attention were seen during the visit. All areas of the home were homely and comfortable and we think that 67 Wellington Road can fully meet the needs of the clients that live there. Aids to help maintain independence, for example bathing aids have been provided. There are fully accessible garden areas available for people. The laundry within the home is well equipped and good systems are in place for the care of peoples clothes. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff members work positively with clients, families and other agencies to improve the quality of life of the people living in the home and a robust staff recruitment process is in place to protect them from possible harm. Evidence: Support staff on duty and rotas seen demonstrated that staffing levels and the skill mix of staff was able to meet the needs of the clients within the home. The staff members were cheerful and friendly and the client spoken with was complimentary about them. According to the manager 12 of the 16 care staff members are currently qualified to National Vocational Qualification [NVQ] level 2 or 3 in care, a recognised qualification for people working in the care profession. The staff file seen contained all of the required information and a robust recruitment procedure was in place for the protection of clients. The managing director of Inclusive Lifestyles who was present for part of the inspection confirmed that all new staff are checked against the POVA list and that a satisfactory CRB disclosure must be obtained before employment commences. The current staff team have the skills, knowledge and experience to meet the diverse needs of the people using the service. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: New staff members undertake a thorough induction training programme which is based upon the Skills for Care common induction standards before they start working with clients; this was confirmed by the staff members spoken with during the visit. 67 Wellington Road povides a range of training courses for staff members these include, moving and handling, first aid, health and safety and adult protection. We were told that all mandatory training was up to date and specific training, for example, specialist medication is provided. There are two staff teams working in the house and each team has a team meeting/training session every two weeks; this is a good system and helps to ensure that all staff are up to date with current developments. A regular one to one supervision system is in place; this was confirmed by both the staff members spoken with and the records seen. Care Homes for Adults (18-65 years) Page 21 of 26 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 being very well run and managed on a day to day basis, this helps to ensure that the needs of the clients are met and that there are appropriate procedures in place to maintain their safety. Evidence: The home has a very experienced and competent manager who displays a clear sense of direction and best practice. She regularly attends courses/training in order to keep her practice up to date and to fulfill her management responsibilities. She is a qualified nurse and is due to start her Registered Managers Award shortly. She can clearly demonstrate an awareness of the needs of the clients living in the home and how to manage the staff team. A deputy manager, team leaders and senior staff members support the manager. This is a strong and committed team who work hard to ensure that the quality of care provided is maintained at as high a level as possible. The staff members spoken with spoke positively about the manager and how the service had developed since it was registered. One of them said; The manager is lovely and genuine. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: Inclusive Lifestyles has an appropriate quality assurance system in place in order to ascertain whether clients and families/professionals are happy with the standards of care being provided. Copies of the forms that are used were provided to us during the visit; these include an easy read format. The managing director said it was intended to link the quality assurance system to the client review process; this would help to ensure that the service provided to an individual is monitored regularly and changes can be made quickly and easily. Clients personal allowances were looked at; these were being well managed. All records seen were being kept securely. Any accidents are recorded and the home manager regularly audits these in order to ensure that any trends are identified and addressed. The home has a comprehensive range of policies and procedures to promote and protect both clients and staff members health and safety. The maintenance records were checked when the home was registered with the CQC. These included, bathing aids, the fire alarm system and the gas and electrical installations. The fire safety log book showed that the tests on the system and emergency lighting were being carried out at the recommended intervals and that drills and training were also up to date. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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