Care Home: The Red House

What the care home does well A thorough process of assessment and gradual introduction to the service takes place before people move into the home. People using the service have comprehensive support and risk management plans which enable them to access the community for a range of activities. In addition people are also supported to develop some independence in certain areas of daily living. Support and risk management plans also provide information for staff to support people with any personal and health care needs. There are generally good medication practices in place. Staff have received training in protecting vulnerable adults from abuse. The environment of the home was well-maintained and clean providing residents with a safe and comfortable environment. Suitable adaptations have been made where necessary. Staff receive a variety of training related to supporting people who use the service. What has improved since the last inspection? Not applicable, this is the first inspection of this service. What the care home could do better: There are two areas relating to the storage of medication which should be improved. Although the home has developed the basis of good recruitment processes there is one area which needs more attention to ensure these are robust enough to fully protect people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: The Red House 25 Barnwood Road Gloucester Glos GL2 0RZ     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: Adam Parker     Date: 2 2 0 4 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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 Red House 25 Barnwood Road Gloucester Glos GL2 0RZ 01452729757 01452729758 Tracey.caswell@yourlifestyle.uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Your Life Style LLP Name of registered manager (if applicable) Miss Tracey Marina Caswell Miss Tracey Marina Caswell Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who may be accomodated is 7 The registered person may provide the follwoing category of service only: Care Home Only (Code PC) to service users of either gender whose primary needs on admission are within the following category: Learning Disability (Code LD) Date of last inspection Brief description of the care home The Red House is a registered care home providing support and personal care for up to seven people with a learning disability. The house is situated in a residential area on a bus route, about two miles from the centre of Gloucester. Single bedrooms are located on all floors. Communal rooms are situated on the ground floor with a small dining area. There is aprivate garden at the rear of the house. Current fees levels were not checked during this inspection visit. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 7 Brief description of the care home The home makes information about the service available to people through a service user guide and statement of purpose available in the home. 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 judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection was carried out by one inspector over one day in April 2010. We (The Commission) requested an Annual Quality Assurance Assessment (AQAA). This was received on time and provided information about what the service feels they do well and any areas they are looking to improve on. The AQAA also contained numerical information called a Dataset. The visit to the service included a tour of the premises, examination of documentation and medication systems and discussions with, staff and management. One person using the service was spoken to briefly during the inspection visit. Care Homes for Adults (18-65 years) Page 6 of 27 We received four survey forms from staff working at The Red House. Care Homes for Adults (18-65 years) Page 7 of 27 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 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. People who use the service receive comprehensive assessments and have opportunities to visit the home before they move in to ensure that their needs and expectations can be met. Evidence: The information gathered for the two people using the service before they moved into the home was looked at. For one person, information had been obtained from the funding authority and from the persons family. The person had been able to visit the home even before refurbishment work had been completed to choose their room. Moving into the Red House took place over a six month period which was managed through a transition action plan. During this time a comprehensive assessment was carried out. A number of visits to the home were arranged before the person moved in including the opportunity to have a meal and to have an overnight stay. Care Homes for Adults (18-65 years) Page 10 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 homes approach to support planning with comprehensive risk assessment and management gives staff clear information on how people can be supported to live their lives. Evidence: People using the service had comprehensive support plans. Detailed actions were recorded for staff to follow in particular with one person, who had a therapeutic behaviour support plan. Another persons support plan detailed how support would be given to enable them to participate in activities in the community. One person was under 18 years old and part of their support plan described how their needs relating to their age would be met through staff actions. This plan used the Supplementary Standards for Care Homes Accommodating Young People aged 16 and 17 as a reference point. Examination of support plans and discussion with the registered manager gave examples of how people using the service were able to make decisions about their Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: daily lives. An example was given of where staff would need to intervene with one person where they may be at risk of eating too much of one particular item of food. For specific decisions that required an assessment of capacity under the Mental Capacity Act 2005 the home had an assessment form drawn up. It was reported that this had not been used so far. People using the service had risk assessments completed which resulted in individual risk management plans. These included specific risks such as absconding and physical intervention in relation to manging behaviour. Another person had a comprehensive risk management plan which included risks arising from specific health problems. Care Homes for Adults (18-65 years) Page 12 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. People who use the service are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of interests and education in order to enhance their lives. Evidence: On the day of the inspection visit one person was in the home and later in the day went out for a drive. The other person using the service was attending college. An activities plan for one person showed that they engaged in a wide range of activities such as going for walks, shopping, clubs, lunch out and arts and crafts. Their support plan reflected their needs when accessing the community in terms of staff actions and ratio of staff. People are also supported to maintain contact with family and friends either through telephone contact or through visits. There were regular meetings with the family of Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: one person to provide feedback on the service being provided. One person had a key to their individual room which they kept locked when out of the home. One person had responsibility for keeping the small kitchen on the top floor clean which they used to prepare meals. An individual weekly plan is kept of the meals to be provided for each person chosen through consultation with them. Care Homes for Adults (18-65 years) Page 14 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. People who use the service are supported to meet their health and personal care needs and there are generally good medication systems in place to ensure that their medication needs are met. Evidence: Support plans detailed the actions that staff needed to take to support people with personal care or if no staff support was required. A section of the support plan for one of the people using the service entitled What I do Like described their preference for receiving support from staff of the same gender. There was evidence of peoples health care needs being met through contact with General Practitioners (GP), dentists,and an optician. A review of one persons care by the local authority and the home had identified the need for input from a chiropodist. The support plan for one person described health problems and gave information for staff as to when medical advice or input would need to be sought. Health problems were also included in the persons risk management plan. The arrangements for medication storage, administration and recording were checked. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: Medication was stored securely and temperatures recorded as a check that medication was being stored at correct levels. A bottle of liquid medication had been opened but the date of opening had not been recorded on the bottle which should be done as an indication of the expiry date. A camera was also being stored in the medication cupboard. The storage of non medication related items should be avoided in the interests of the security of medication storage. The cabinet for controlled medication was checked and was in line with current legal requirements in terms of wall fixings. There were no controlled drugs being stored in the home at the time of the inspection visit. Examination of the Medication Administration Records (MAR) showed that there were no gaps in the recording of administration. Where medication is prescribed on an as required basis there were individual written guidelines for staff to follow in the individual persons support plan. One person was self medicating and there were secure storage arrangements in place in their individual room as well as a risk assessment. Weekly medication checks were in place that looked at storage and recording. The homes AQAA document told us how all staff receive accredited training in handling medication. Care Homes for Adults (18-65 years) Page 16 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. Systems are in place that safeguard people from possible harm or abuse and allow for complaints and concerns to be raised by them or on their behalf. Evidence: The home had a complaints register and information about two recent complaints were looked at. These had come from neighbours of the home and not from people using the service of their representatives. Full details of the complaints and the response by the home had been documented. The complaints policy stated that complaints would be investigated within 28 days of the home receiving them. All of the staff who responded to our surveys indicated that they knew how to respond if someone had concerns about the home. The home has a policy and procedure for dealing with allegations of abuse to people who use the service. This includes referring the issue to other agencies such as the local authority and the Commission. In addition the home has a whistle blowing policy setting out guidelines for staff who may need to report any issues of concern. Staff in the home have received training in protecting vulnerable adults from the local authority through their Alerters training. In addition the registered manager had attended the local authoritys Enhanced training in protecting vulnerable adults. Training in child protection, relevant to the person using the service under 18 years old had also been planned for staff working with that person. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Staff receive training on dealing with challenging behaviour at induction. Support plans directed staff to use physical intervention as a last resort. Where this had occurred it had been appropriately recorded and reported to us. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the benefit of living in a well-maintained and clean, environment with personalised individual rooms. Evidence: A tour of the premises was undertaken. All areas of the home inspected were found to be clean, well maintained and decorated and smelt fresh throughout. On the ground floor there were three communal rooms, one with a large television screen mounted on the wall and another with a small dining area. Only two rooms were occupied at the time of the inspection visit. One room was looked at, this had been adapted in order to provide a safe environment for the person in relation relation to managing certain behaviour. The room also contained various personal items and had been decorated in the persons favourite colour. On the top floor there was a small kitchen and two individual rooms. The kitchen was being used by the person occupying the room on that floor to prepare meals. It was noted that there was some raised floor covering on the stairs towards the top floor. This was pointed out to the acting manager at the time. At the rear of the home was an enclosed garden. The laundry had washable floor and wall surfaces. At various points around the home such as in the laundry and the top floor kitchen, hand cleansing gel was available from dispensers. On one of the staff survey forms we received, a response to the question What does Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: the home do well? was a clean, well maintained home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training is undertaken in a number of areas to equip staff with the knowledge and skills to meet the needs of people who use the service. However some improvement is needed to one aspect of recruitment practices. Evidence: The staff training matrix supplied at the time of the inspection visit showed that out of nine staff, six had achieved an NVQ at levels two or three with the remaining staff having started an NVQ at level two. In addition, all staff had received training in Equality,Diversity and the Management of Challenging Behaviour. Recruitment records for three members of staff were examined. For two staff members all the required information and documentation had been obtained including an employment history against which any gaps in employment could be explored. However with a third member of staff a full employment history had not been supplied on the application form. In addition there was no record to show that this had been discussed at the interview. The staff member had also indicated that they had previously worked in a post involving contact with children and there was no evidence that the reason for leaving this employment had been verified or the nature of the post discussed at interview. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. Written references Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: were being checked verbally which was good practice. The homes AQAA described how people using the service would be involved in the recruitment of staff and the registered manager described the involvement of the parents of one person in the process of recruitment. Induction is provided to staff when they commence work in the home. All staff recruited had previously worked in care so none were offered induction training to national specifications. However three staff have are undertaking training for a Learning disability qualification. We received four completed survey forms from staff. Three indicated that they received training that was relevant to their role and helped them to understand and meet the individual needs of people using the service. One staff member did not respond to this question. 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 home is well managed with staff trained in safe working practices and a planned quality audit to ensure that the home is run in the best interests of people who use the service. Evidence: The registered manager has a background of working with people with a learning disability. She has achieved the registered managers award and an NVQ level five in Health and Social Care as well as a Diploma in management. At the time of the inspection visit an acting manager was managing the home on a day to day basis and had started the process of making an application for registration. Reports of visits made under the Care Homes Regulations 2001 were looked at. The reports were detailed with evidence that people using the service, their representatives and members of staff had been consulted about the service that was being provided by the home. The registered manager described plans for a quality audit using questionnaires aimed at families of people using the service, care Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: managers and staff. The responses to the questionnaires would form a development plan. This was to start in November 2010 when the home had been open for a year. Staff have received training in safe working practices in the areas of fire safety, food hygiene, infection control, health and safety, first aid and moving and handling. Although no specific moving and handling of people was being carried out in the home. Checks were made on hot water temperatures with records kept. Cleaning substances were being stored in their original containers in the laundry which was kept locked. People using the service had supervised access to the laundry when needed. The electrical wiring in the home had been checked in 2009 as well as the portable electrical appliances and the heating system. Window restrictors are fitted to upper floor windows. 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 1 32 19 Before a person starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations must be obtained. This is to ensure that residents are protected through robust recruitment procedures. 30/06/2010 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 2 3 20 20 24 Bottles of liquid medication should be dated on opening as an indication of their expiry date. The medication cupboard should only be used for storing medication and not for other non-medication related items. Check the situation with the raised floor covering on the stairs towards the top floor, so that this is safe for anyone using the stairs. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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