Care Home: The Hermitage

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What the care home does well A number of improvements have been made to the service as detailed in the following sections of this report. The manager and staff team are continuing to ensure that the quality of the service is regularly reviewed and that improvements are identified and then made. Given the uncertainty surrounding the service being transferred to another provider at some point it is noted that the team remain energetic and committed to providing a quality service. The ethos of the service is clearly aimed at working with people in a way that acknowledges and respects their rights as human beings, regardless of the complexities of each individual`s care and support needs. The staff team are clear about the purpose and function of the service and their responsibility to maximise the life opportunities of the people who live here. What has improved since the last inspection? The service now ensures that each persons individual risk assessments are kept under review. The wedging open of bedroom doors does not now occur. When planning staff training the service has taken into account that one person is registered blind, some people have epilepsy, some people have physical disabilities and some people have needs related to increasing age. The night time staff receive supervision and training on the same frequency as daytime staff and most have now had training about adult protection. The Surrey and Borders NHS Trust now ensures that Regulations 26 visits are carried out at the home in order form an opinion of the standard of care provided. What the care home could do better: Communal areas require decorating, not least the hallways. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Hermitage 17 Dunheved Road South Thornton Heath Croydon Surrey CR7 6AD     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: James Pitts     Date: 2 3 0 7 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 27 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 27 Information about the care home Name of care home: Address: The Hermitage 17 Dunheved Road South Thornton Heath Croydon Surrey CR7 6AD 02086650204 02086651084 kim.baldacchino@sabp.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Surrey and Borders Partnership NHS Trust care home 10 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: A variation has been granted to allow one specified service user over the age of 65 to be accommodated for as long as the home is able to meet their needs or until the placement is terminated. Date of last inspection Brief description of the care home The Hermitage is a ten place residential home for people with learning disabilities. Some people also have physical disabilities. The home is a large detached house situated in a mainly residential road in Thornton Heath close to local shops and transport. The home is within easy reach of Croydon town centre and all its facilities. Each person has their own bedroom, which is personalised to their own tastes. There is also a large dining room, communal lounge and an activities room. There is a large 10 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home garden to the rear of the house, which is well used in the summer. Care Homes for Adults (18-65 years) Page 5 of 27 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: The quality rating for this service is 2 stars. This means people who use this service experience good quality outcomes. The charge for the service is presently between 61,586:99p per annum. The previous key standards inspection took place in August 2007 and since that time an annual service review was carried out in 2008. The service currently accommodates 8 people and most of these people were present during the inspection site visit. Methods of inspection included a tour of the premises, observation of contact between staff and people who use the service, discussion and interaction with some of the people who use the service and discussion with the manager. Care Homes for Adults (18-65 years) Page 6 of 27 Records that we examined included the homes Statement of Purpose and Service Users Guide, care plans, person centred plans, risk assessments, complaints, adult protection, training, medication, and health and safety. Requirements and recommendations from the previous inspection were also discussed with the manager. 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. 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service and others are told what the home does and how it will do it. The service user guide has been improved to enable as many of those who live here as possible to understand it. The people who use the service can continue to feel confident that the home will only care for people that the staff are trained and able to care for. Evidence: We looked at the home Statement of Purpose and Service Users Guide (Residents Handbook). The Statement of Purpose and Residents Handbook are available to all in pictorial format. They are each kept up to date with detailed information on the services and support provided. These also explain how the service staff team will meet individual needs. No one new has moved into the service since the previous key standards inspection in 2007. The most recent admission to the service was in fact over 5 years ago. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: The primary care need of all of the people who use the service is learning disabilities. However, some people also have a physical disability and use wheel chairs. This is now reflected in the statement of Purpose as recommended at the previous key standards inspection. Care Homes for Adults (18-65 years) Page 11 of 27 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 people who use this service can feel confident that staff know what they need. They can also be assured that the staff will make sure that each person has the opportunity to maximise their opportunities to live the sort of life that they can meaningfully chose to. Evidence: We looked at the care plan and review information for two of the people who use this service. Both people have Person Centred Plans and both have had their care plans/placements reviewed by a care manager from their placing authority. Person Centred Plans included headings such as what matters to me, things I enjoy, my future, things to do in order to keep me healthy, my dreams, a relationship circle and how I communicate. We noted at the previous key standards inspection that one persons risk assessments had not been reviewed. It was then recommended that all people who use the service have their risk assessments kept under regular review. We looked at a number of risk Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: assessments and these showed that reviews now occur at regular intervals. All staff have undergone further training about care planning Maps and Pathways. The result of this is that there is far better awareness of how to support people who use the service with their Person Centred Plans. There has been continued improvement about how communication occurs with the people who use the service. There are picture menus and rota indicating which staff are working and the planned activities for the day. There are also continuing workshops for staff to attend about responses to challenging behaviour and working and communicating with people with a learning disability. The people who use this service still get together every three months for a house meeting. This forum is used to discuss and share information about the running of the home and plans for the future. Care Homes for Adults (18-65 years) Page 13 of 27 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. The people who use this service can feel confident that the staff of the home will provide enough active support for each person to participate in the community both in terms of the activities of daily life and leisure interests. The opportunity for each to maintain personal and family relations continues to be encouraged and is actively supported by the staff team. Evidence: Each of the people who live here is said to be supported by the staff to be as independent as possible and to make as many choices as they knowingly can. All of the people who live here continue to have a varied programme of activities and there is continuing improvement to the nature and variety of these activities. The people who use this service frequent local cafes, hairdressers, barbers, shops, Saturday and Monday Clubs. An Aroma Therapist also visits and there is a sensory Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: room for people to use for relaxation. Everyone has the opportunity to go on holiday each year either alone or with others if they choose to. Holidays are being planned at present and one person spoke about options they are considering. Most people have freedom passes and people who use wheelchairs sometimes use the Computer Cabs firm for transport. The home has two minibuses and people regularly go on day trips further a field. People are able to keep in contact with their relatives. The home has an open visitors policy and staff just ask that people phone ahead of any visit to check that the person is at home. Staff support one person home so that they can spend the day with their parents. All others are in touch with their families through invitations to PCP meetings, BB Q, Christmas parties, Birthdays and other events. The homes menus are compiled on a four weekly rota basis. The menus reflect choices agreed at three monthly service user meetings. They are changed seasonally and also take into account individual dietary needs. The service has the opportunity to seek the advice of a dietitian for some people as or when necessary and appropriate guidelines are in place. Care Homes for Adults (18-65 years) Page 15 of 27 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 people who use this service can feel confident that they will get support to take care of their personal and health care needs. Anyone who needs to take medicine regularly to help them stay well will receive assistance from staff to make sure that this happens. Evidence: All of the people who use the service are registered with a General Practitioner. People are able to access community health facilities such as opticians, chiropodist and district nurses as required. Person Centred Plans indicate level of support needs and how they prefer personal care to be carried out. Medication is stored in a locked cabinet in the dining area. Medication administration records that we examined were accurate and up to date. The medication folder contained a medication profile, photographs and guidelines for the administration of as required medication. The manager provided evidence that all medication is checked and balanced every week and all staff attend medication training at periodic intervals. Some people have been diagnosed with epilepsy. The medication folder contained an Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: epilepsy care plan for each person with epilepsy. The care plan included a description of typical seizures, guidance for staff to follow, a rectal disappear treatment plan and a seizure chart. As was required at the previous key standards inspection all members of staff have attended first or refresher training about epilepsy and how to respond to people who suffer seizures. It was also previously recommended that all staff attend training on the assessed needs of individuals living at the home. This planned training to take into account the fact that one person is registered blind, some people have physical disabilities and some people have needs related to becoming more elderly. It is noted that this training has occurred. Assessments for osteoporosis have also been requested for the older service users. The home has the support of a pharmacist for advice. No advice was provided last year this has recently commenced again. A visit occurred earlier in the week of this inspection site visit and the report of the pharmacist findings of that visit is expected by the service shortly. The manager did, however, say that they were not informed of any significant concerns about medication management during that visit. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The service has clear guidance for staff about the procedures to be followed in either of these circumstances. Evidence: The people who live here, and others, are given clear information about how to complain and what happens when they make a complaint. It was recommended at the key standards inspection in 2007 that a copy of the complaints procedure is provided to all relatives, which was then achieved. One complaint was recently made by a neighbour directly to the service since the previous key standards inspection in 2007. This is of a minor nature and should be resolved soon. No complaints have been made directly to the Commission during this same time period. There is clear written guidance and information for staff about what to do if they think that anyone who lives here is being hurt or abused by another person, or if an allegation is made by a third party. No concerns about harm or abuse have been raised since the previous inspection and all staff have been, or are being, scheduled to attend updated training about safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that they are living in a well maintained and sufficiently pleasant environment in the short term, although redecoration of communal areas, specifically the hallways, is required. Evidence: It was observed at the previous key standards inspection that one bedroom door was wedged open. It was then required that wedging open of doors must cease and this now no longer occurs. The home has a large garden with patio and good quality garden furniture. Bedrooms are decorated to individual personal choices. On the day of the inspection the premises was clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. Skirting boards on the ground floor were seen at the previous key standards inspection to have been scratched by wheelchair use. It was recommended that the registered manager consider redecoration of the communal areas in particular the skirting boards. The specific damaged area was then attended to, however, it is now the case that the communal areas, particularly the hallways, are looking worn and are now in need of Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: decoration. The trust should inform the Commission in writing of a plan and timescale to achieve this. The service continues to employ a domestic member of staff who cleans the home and staff support and encourage the people who use the service to do lighter daily cleaning chores. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that there is a committed staff team to meet their needs and that these staff are safe people to support them. Evidence: We looked at one new member of staff recruitment records and background checks. This was the only newly employed person since the previous key standards inspection and the records showed that a proper recruitment process has been followed. CRB checks were also seen for the remainder of the staff team and these verified that safe people are employed. The staff team are said to continue to have access to a training and development programme, and the annual appraisal process is currently underway. The dates for these appraisals were seen to be planned on the staff supervision schedule. Just over 70 percent of the staff team are qualified at NVQ level 2, with some having level 3. Two staff are currently training to be NVQ assessors which would compliment the manager who already achieved this qualification. Records of training courses that each member of staff has attended are also kept. Staffing records now show that all staff have regular recorded supervisions and the service is on target to meet the minimum requirement of at least six supervisions each year. The manager carries out supervisions but stated that more senior staff are to be trained in the near future so this can be shared more widely amongst the Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: management team. Care Homes for Adults (18-65 years) Page 22 of 27 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 people who use this service can feel confident that they are living in a home that has effective internal and external management oversight. Evidence: The registered manager has managed The Hermitage for five years. She is a Registered Nurse Learning Disabilities and has completed the Registered Managers Award. She is currently completing NVQ assessors Units A1 and A2. It is no longer a requirement under the Care Homes Regulations that regulation 26 reports are sent to the Commission unless it is requested. When we examined copies of the regulation 26 visit reports for the last twelve months it was seen that these are occurring each month. The service is now receiving these reports. The manager stated that people who use the service and their relatives have all been sent satisfaction surveys for the current year but none has yet been returned. All of the necessary health and safety checks have been carried out including those Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: specifically related to fire safety. The electrical circuits are due for a re test soon although the provider does already know about this and arrangements are being made to ensure that it is completed. Care Homes for Adults (18-65 years) Page 24 of 27 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 27 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 1 24 The registered provider should inform the Commission in writing of the plans to ensure that communal areas of the home are redecorated. Care Homes for Adults (18-65 years) Page 26 of 27 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). 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