Care Home: The Seashell Trust - The Royal College Manchester

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What the care home does well The manager makes sure that peoples needs are fully assessed and are given opportunities to spend time at the service so that the best steps are taken to facilitate a successful placement. The manager makes sure that people have a clear, detailed and individualised plan of care so that all concerned know what they must do to support each person to achieve the best outcome for themselves. The manager makes sure that there is effective communication so that people can make decisions about their day to day life. The manager makes sure that the agreed steps are taken support people to reach their full potential in relation to education and occupation. The manager makes sure that people do not become isolated from friends or family and are also offered opportunities to become involved in the local community. The manager ensures that the routines of the service are flexible enough to meet individual needs, including outings, meals and mealtimes and activities. The manager had policies, procedures and training in place that promotes peoples dignity and reiterate to staff the importance of treating people with dignity, privacy and respect. The manager ensures that people’s wellbeing is safeguarded through their receipt of effective health care. The manager ensures that people are aware of their right to voice concerns and make complaints. The manager ensures that students benefit from staff that are well trained and supported to do their jobs. The manager ensures that the health, safety and welfare of people concerned with the service is promoted and protected so that they remain protected from preventable harm.The Seashell Trust - The Royal College ManchesterDS0000073259.V376835.R01.S.docVersion 5.2 What has improved since the last inspection? This is the first key inspection. What the care home could do better: The manager needs to ensure that medication is in the units is monitored by people who have a responsibility for administering the medication and that it is always accurately monitored. The manager needs to ensure that the fittings and fixtures on all the units are clean and in good repair, particularly flooring and carpeting in hallways and kitchens. One unit particularly needs to be redecorated as the walls are badly damaged and the carpets in all the communal areas were heavily stained and worn. The manager also needs to make sure that communal areas such as dining rooms or lounges are consistently furnished to look homely, as this may help make people feel more settled if the environment looks less institutional. Key inspection report CARE HOME ADULTS 18-65 The Seashell Trust - The Royal College Manchester Stanley Road Cheadle Hulme Stockport Cheshire SK8 6RQ Lead Inspector Michelle Haller Key Unannounced Inspection 08 September 2009 10:00 th The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 2 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 The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Seashell Trust - The Royal College Manchester Stanley Road Cheadle Hulme Stockport Cheshire SK8 6RQ 0161 610 0100 0161 610 0101 Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sea Shell Trust Ltd Mrs Jill Christine Taylor Care Home 50 Category(ies) of Learning disability (45) registration, with number of places The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only- Code PC To people 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 people who can be accommodated is: 45 Date of last inspection New Service Brief Description of the Service: The Sea Shell Trust is a large organisation that includes a school and college, domiciliary care agency and residential units and used to be called The Royal School for the Deaf and Communication Disorders. This residential service was newly registered with the Care Quality Commission on the 23rd March 2009. The Seashell Trust –The Royal College Manchester Care Home provides personal care and accommodation for 45 young adults with a learning disability. Seashell Trust care home is located on a shared site with The Royal College Manchester. All the young adults have a severe or profound learning disability together with severe communication disorder and / or a hearing impairment and associated complex needs. Seashell Trust care home consists of 7 buildings, West Lodge, Witton North, Witton South, Eddison, Orchard, Spalding and Hipkins. All of the properties are located very close together. The properties are referred to as residential units. The service is set in large landscaped gardens and there are good public transport and road networks near by. Each education and support package is different and so students are funded by their local education authority in accordance to their educational needs. This will be the first CQC inspection completed since registration. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We conducted this key inspection without informing the manager before hand and we looked at all of the most important or key Care Homes for Adults (1865) National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the service. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We received nine completed Care Quality Commission (CQC) surveys from staff. We spent time at The Sea Shell Trust residential units between 10:00 and 18:00 on the first day and 10:00 and 13:00 on the second day. We visited each of the seven units and talked to staff and observed the student who were in residence. We checked through written information, including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the service. We interviewed staff and observed the way people were treated. The manager returned to us the CQC Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks. This information also influences the outcome of the inspection. During the inspection period Jackie Whiting the Deputy Head of Care and Jill Taylor Head of Care and Registered Manager assisted with the inspection. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 6 What the service does well: The manager makes sure that peoples needs are fully assessed and are given opportunities to spend time at the service so that the best steps are taken to facilitate a successful placement. The manager makes sure that people have a clear, detailed and individualised plan of care so that all concerned know what they must do to support each person to achieve the best outcome for themselves. The manager makes sure that there is effective communication so that people can make decisions about their day to day life. The manager makes sure that the agreed steps are taken support people to reach their full potential in relation to education and occupation. The manager makes sure that people do not become isolated from friends or family and are also offered opportunities to become involved in the local community. The manager ensures that the routines of the service are flexible enough to meet individual needs, including outings, meals and mealtimes and activities. The manager had policies, procedures and training in place that promotes peoples dignity and reiterate to staff the importance of treating people with dignity, privacy and respect. The manager ensures that people’s wellbeing is safeguarded through their receipt of effective health care. The manager ensures that people are aware of their right to voice concerns and make complaints. The manager ensures that students benefit from staff that are well trained and supported to do their jobs. The manager ensures that the health, safety and welfare of people concerned with the service is promoted and protected so that they remain protected from preventable harm. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 7 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. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living accessing the Sea Shell Trust residential service benefit from having their needs fully assessed before a placement is started so that everyone knows what is needed to enable a person to settle in successfully. EVIDENCE: We looked at seven files for people who live at Sea Shell Trust. Three of the files were for people who were due to move into the service. We saw that in the majority of cases detailed assessments of peoples needs had been conducted. We saw that assessment information came from a number of sources including the young person, their carer and family and others such as speech and language therapist, social workers and previous educational establishment. We noted that the Sea Shell Trust admission policy states that ‘Representative staff will visit the pupil’s current placement and home to seek first hand information from parents, carers and from professionals currently working with the young person including medical information. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 10 We talked to the Transition Coordinator who is a member of staff whose role was to be the link person before new students moved to Sea Shell Trust. She informed us that she visited people at home and explained about the service and people were able to ask questions. She confirmed that she visited people at home and at school and that she also became acquainted with the health and social care professionals supporting an individual. She confirmed that she arranged for visits to be arranged for people. These visits were to allow for a smooth transition to the Sea Shell Trust. We were told that the period and style of transition depended on the assessed needs of the individual. For example some people did not visit prior to the move because this could be too disturbing whilst others enjoyed overnight stays during the summer holiday. We looked at people’s reports, admission records and correspondence in peoples care files and the information confirmed that people’s needs were comprehensively assessed before they moved to the service. The assessment information was collected over a period of time and included: the type of accommodation including the compatibility with other people; activities, educational needs and social and leisure interests; family and social contact; cultural and faith needs; physical and mental health; specific conditions, and additional information about the condition, how it effects the person and how it should be managed. The assessment also included information about specialist equipment or management of the environment and treatment and support in relation to behavioural or emotional intervention needs. We saw that the communication assessments were very detailed. Each assessment was individualised. It was clear that each person was assessed as an individual. We saw on each file a detailed care plan that took into account all the information provided at the assessment process and observations made by staff during the transition process. We noted that there were detailed multi -agency risk assessments and support plans in respect of interventions that that may affect people’s freedom of choice. We discussed with the registered manager issues relating to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and it was confirmed that this training was been undertaken by staff and that the Care Plans had been redesigned to take this issues into account. The manager also said that existing Care Plans were to be updated so that this safeguard was taken into account. People who commented told us that ‘The knowledge of the students is well done with the care plans providing detailed information when first working with new students. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the 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 at Sea Shell Trust are supported in making their needs and choices known through effective communication between all concerned including the student resulting in positive outcomes in relation their decision making and risk taking. EVIDENCE: We looked seven files for people who had used the Sea Shell Trust services for some time. We found that clear and detailed care plans had been developed from the assessment information; we also saw that these were reviewed and updated in keeping with the needs of the individual. We noted that assessment and care plans were signed by the relatives. We also noted from the attendance lists, that care planning was a multidisciplinary process and that The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 12 communication between all concerned was effective and resulted in the aims of the care plans been met. We found the information in each care was very different and specific to the needs of the individual. We found that the information in the care plans demonstrated that each person’s individual personality, interest, abilities, motivation and communication needs was fully taken into account. No two care plans were the same, even when the needs identified might be similar. We found that the care plans described restrictions on choices and freedoms in relation to supporting people to meet their goals. We found that these issues were planned and agreed following close observation and assessment of how best to achieve the desired goal. We discussed the implication of the DoLS recommendations and the manager confirmed that the format of the care plans had been changed to ensure that this aspect is always taken into account so that the correct steps are taken. We found that communication methods used with people was individualised and effective. We found that this good communication promoted peoples independence and ability to make choices about their lives. The communication methods which we saw on the day of inspection included use of pictures to support people in every aspect of daily living, including relationships with each other and staff. We saw effective use of British Sign Language and speech. We saw and were told, that signing was modified to suit the individual person. We saw in people’s files pictures of their unique sign for different words, and we saw that staff used these signs very effectively. We saw people who did not use speech communicating complex information, including their feelings, to staff and staff were able to respond quickly to meet people’s needs. We saw that the basic information in care plans such as dietary preferences, travel arrangements, time at college and agreed timelines for events were set out pictorially and that they were understood and used by the people concerned. We found that throughout the day we observed staff respecting peoples rights to make informed decisions about their lifestyles. We noted that people were able to have showers when they wanted, have meals of their choice within healthy eating parameters, spend time alone or in a group, or stay in or go out. We discussed the issue of choice with staff who identified that through working with people as individuals and developing effective communication people were able to have more choices in life. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 13 We saw that risk assessments plans were developed if the assessment and care planning process identified potential issues. We noted that these assessments were developed by a multidisciplinary team and included the person and their family. We noted that the aim of intervention was to mitigate the risk not eradicate it. We were told by staff that: ‘There is a wide circle of support such as residential social workers, speech and language therapists, mental health nurses and other therapists and we support the parents and students input when ever possible.’ The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students who live at a Sea Shell Trust residential unit have the opportunities to gain independence and enjoy a life style in keeping with their wishes and abilities. EVIDENCE: We found that the Sea Shell Trust residential service caters exclusively for young adults who have been accepted to attend the educational establishment which is on the same site. We note that each student’s timetable was made known to the staff and that they developed a means of communicating this information to each student. We saw that there is very liaison and working between the college and the residential service, because self-help gaols that were set in college continued to be encouraged and monitored at home. We found that people’s experiences were extended and their horizons broadened The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 15 through attending the college and living in a residential unit run by the Sea Shell Trust. We saw through reading daily diaries and activities calendars that people had access to a wide variety of activities. These often involved accessing the local community and made use of local amenities such as supermarkets, pubs, restaurants and Churches and businesses. Records confirmed that people were supported to complete work experience and leisure activities such as participating in and attending sports events, going to the cinema, theatre and concerts Church run clubs and uniformed organisations such as the Scouts. The Trust owns its own transport however the manager told us in the information she returned that: ‘We have widened our community activities including the majority of service user using public transport.’ We noted through observation of the interactions between people and staff, and assessment information and daily records that attention is paid to supporting people to develop friendships or maintain good relationships where ever possible. We also saw that how people may relate to each other is taken into account when considering which house or flat people should be offered. We saw that the service offers a guest room for relatives who want to stay overnight while visiting or helping the person to settle in. We noted in assessments, care plans and daily records that daily contact is agreed and with the person and their relatives and that arrangements are made to ensure that people can spend time at home as agreed. We noted that people are supported in maintaining their place in their family. We noted that there was a list of significant dates such as birthdays and anniversaries. This is so people are reminded and supported to buy cards and presents to be sent home to their friends and families. We saw from the daily calendars that although structured through necessity in the main daily routines were flexible enough to meet the needs of people living in the different units. We saw that week ends had a more relaxed time table in relation to getting up and food preparation. We noted that there were rotas n place so that each person had a fair share of the house work, shopping and cooking chores. We noted that there were signs on doors to inform staff of how best to ask permission or alert someone that they would like to enter their bedroom when this was applicable. We observed very positive and affective interactions between staff and students. We saw people communicating with staff through use of picture, The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 16 body language, standard British Sign Language, modified BSL and Makaton. We noted that people were confident in approaching the staff and that staff tried different techniques, which were gentle and non-threatening, to persuade people to stick to their Care Plan. We noted that different meals were served on each unit. Each unit has a budget for their own shopping. We saw that people were involved in planning and preparing the menus and different means of communication used if required for example pictures or signing. We were informed that in order to make the task manageable for the individual, certain tasks were broken down for example with food shopping, some people are supported to purchase a certain number of items for the weekly shop. We noted on one unit that people were having a late lunch because they had got up late. The lunch was sausages, hash brown and beans. The meal looked nicely prepared and people who wanted more received extra. We noted that staff had their meals at the same time which helps to model to people acceptable table manners. We noted that cultural and religious laws were respected and health assessments and care plans highlighted special dietary requirements and how these were to be met. We were informed that a student who was Muslim was due to start placement the day following the inspection. When I visited the flat and talked to staff they said ‘I’ve just been out to buy Halal meat.’ The training calendar confirmed that all staff had completed food hygiene training. Staff who returned surveys commented about the lifestyle experienced by students and said: ‘I think we meet the needs of the students very well following a 24 hour curriculum.’ ‘The home meets the students’ needs in every way e.g. arranging activities for the student to do.’ And ‘The equipment provided for the students also meets their needs and the activities provided keep the students entertained.’ The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Student at Sea Shell Trust have their health and personal needs met in keeping with their needs, the managers need to make sure that the systems in place for monitoring medication is a safe as possible. EVIDENCE: We examined people’s records and found that each person had an individual health action plan that described all medical needs in detail. People also have access to a team of medical; staff employed by the agency they include Mental health nurses, physiotherapist, speech and language therapists, occupational therapists and other professionals with specialist knowledge in relation to people who function on an autism spectrum or have specialist communication needs and learning disabilities. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 18 We saw from application forms and other correspondence that people are supported in signing on at the local GP practice if they have come from outside of the area. Records also confirmed that people were supported to access primary health care such as dentists and opticians. There was also written reports confirming that staff also supported people to attend specialist health care investigations. Staff who returned surveys confirmed that they were provided with enough information to deal with people’s health needs. We saw that staff received specialist training in how to deal with the particular health issues of the residents. This training included dealing with epilepsy or particular syndromes. Staff also received specific training in how to deal with specialist equipment such as Peritoneal Gastric feeding. We saw that health needs were carefully monitored and the appropriate steps taken quickly to prevent conditions from becoming worse. We looked at the medication records on three units. We saw that there was a list of sample signatures for staff trained to administer medication. We noted that there were pictures of the students on their medication administration records, and that there were no unexplained gaps in the records. Medication was stored safely. We saw that there is a clear policy and guidelines for the use of over the counter or ‘Homely’ medication. We saw that this is risk assessed, recorded and timescales and the number of doses allowed before seeking medical attention strictly laid down. We also saw that there was a policy detailing the longest time delay allowed for medication, depending on the number of times it needed to be administered in a 24 hour period. This was useful to staff because it meant that they were confident in how to manage medication in relation to the choices students may make in relation to being ready to take their medication at the allotted time. We noted that staff who administer the medication are not responsible for monitoring the medication they receive; we were told that this takes place in the medical unit. We assess that the system for receiving and monitoring medication would be safer if the staff responsible for actually administering the medication were able to confirm that the medication received was correct when it came into the unit, and also aware of precisely what and how much of medication had been sent across. We looked at the management of medication that needs to be monitored very carefully and stored securely. We found that more diligence is needed to make sure that the records are kept are up-to-date and accurate. These matters were discussed with the manager of the service. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the 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 at using the Sea Shell Trust service have their wellbeing safeguarded by the use of a robust and clear adult protection policy that is understood and used by staff, they also have their rights safeguarded by been supported to make their complaints known. EVIDENCE: We found saw that a picture format of the complaints procedure was clearly displayed on each unit. We noted that this provided information about people’s right to complain and how these would be dealt with. WE looked at the complaint procedure and found that it was clear and detailed the timescales and outside organisations that could be contacted if issues were not dealt to the satisfaction of the complainant. We found that all staff had completed adult protection and child protection training. We discussed this issue with a member of staff. This person was very clear about the actions she would take to safeguard against adult abuse and how to respond if there was suspicion that abuse had occurred. There has been one adult protection investigation conducted in the service since its registration. This investigation is drawing to a close and all documentation concerning this was looked at. We found that Stockport Adult The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 20 protection protocol was followed and that appropriate steps were taken to deal with the situation. We saw that support was provided to those concerned and the complainant was reassured. We discussed the matter with the members of the management team who felt that they had learnt a lot about customer care and staff care during the process. The management team have decided to provide more written information to staff about the process of what will happen if an accusation is made against them. The management will reiterate the principle of ‘suspension without prejudice’ and introduce a buddy system in an effort to reduce the stress that the process may place on staff. Although a Care Quality Commission notification was sent we did not receive this until the case was near conclusion. We would like to request that when safeguarding issues arise that the registered person informs CQC by telephone and then follow this up using the written notification. We discussed issues concerning restraint and the frequency and levels of constraint. The manager stated that full restraint was an extremely rare event in the service. The manager agreed and understood that the organisation would inform us of any incident concerning full restraint, or which resulted in multidisciplinary team involvement such as social workers or other therapists. This is so we are informed of major events concerning physical intervention and how they have been handled, and so that the service complies with Care Homes Regulations concerning notification of death, illness and other events. The manager agreed to add these instructions to the relevant policy and guidelines and should cascade this information to staff. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the 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 Sea Shell Trust needs to take further steps to ensure that all the furniture fittings, adaptations, decoration and equipment is clean, domestic in nature and in good repair on all units, to show that everyone is equally valued and able to benefit from living a pleasant environment. EVIDENCE: There are numerous departments and units for different purposes. On site facilities includes a swimming pool which is also used by the local community, a snoozlen or relaxation room, and a gymnasium or sports hall. We saw that a part of the grounds has been landscaped into a sensory garden which very pleasant to walk through. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 22 We visited all of the seven units of the Sea Shell Trust adult residential service. We found that some units had been decorated in mostly neutral colours and that attempts were been made to make each unit homely and attractive, and also meet the different environmental needs of the people living there. We saw that all bedrooms were personalised and many people were able to choose the colour of their rooms, the bedding, curtains and colour of the carpet. We noted that all bedrooms were clean. Communal areas were generally well equipped and provided comfortable seating and allowed for people to enjoy watching television, having discussions or just sitting. Cooking and laundering facilities were all domestic in nature and enabled people to do their own laundry, cooking and cleaning. We noted that each house had a rota for domestic tasks. We also noted that the support required for each individual was assessed both at college and on the unit so that this was consistent between the two places. We saw on one unit that a rise and fall sink had been installed so that people who needed to remain seated could participate fully in the kitchen and food preparation. We noted the need for substantial improvements in relation to fixtures and fittings on a number of units. We noted that on Hipkins unit, for example, the dining room looked like an office. The furniture was stark, there were folders on display and the look of the room was quite bare, especially in contrast with the living room and peoples bedrooms. We discussed this issue with the management team who felt that different filing cabinets or cupboards would help to solve this problem, and that these were on order. We saw on Orchard that the carpets were heavily stained and very grubby looking. In addition the paint on the walls was very scuffed and scratched off. Aspects of the communal areas did not look homely and televisions and some other equipment was boxed in. It was explained that this was to meet the needs of the student group who may use this equipment as an inappropriate means of communication. The bedrooms on this unit had been personalised according to the taste and interests of each person, and people were seen accessing their bedrooms when they want. We saw that the bathing and showering facilities on each unit meets the needs of service users. Many of the units had a lot of corridor and this seemed to suit people who wanted to walk around. One unit was a small house and this was very homely and domestic. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 23 We saw that equipment such as hoist and track was available for use and people’s physical needs were taken into account when deciding which unit they should be offered. We looked at the most fire warden report and found that no omission had been discovered that required urgent attention and that recommendation that had been made had been complied with. We assess that the Sea Shell Trust needs to take further steps to ensure that all the furniture fittings, adaptations, decoration and equipment is domestic in nature and in good repair on all units, to show that everyone is able to benefit from living a pleasant environment. Comments about the environment included: ‘The houses need updating and decorating.’ The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People using the 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 benefit from a staff team who are well trained and supported to do their jobs effectively and who are recruited using polices and procedures that promote the employment of suitable people. EVIDENCE: We looked at the staff records for five people. We saw that each one held a copy of the original application form for working with the organisation. There were two and at times three references and a copy of the Criminal Record check number or certificate itself. We saw from the training records that courses that the training offered was varied and would prepare staff for working with the people who lived within a Sea Shell Trust residential home. We found that in-house training took place every Tuesday and that sessions were repeated to ensure that all staff were able to attend. We found from the The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 25 training calendar that specialist training was also brought in whenever necessary. We found that training was also provided around the specific needs of an individual person. We saw that topics for training included: IT awareness; manual handling courses and refreshers; medication training, including how to manage specific medication; First Aid courses including a four day course with an examination and 1 day refresher; Basic Nutrition and Basic Food Hygiene and Safety; Autism Awareness; Mental Illness; Depression Awareness, Equality and Diversity levels 1 and 2; conducting supervisions; Anxiety Awareness; Getting Help in a Crisis; Behaviour management and refresher; Receiving supervision; Team Building; Appointed Person under the Mental Capacity Act; Safeguarding and Protection of Vulnerable Adults (POVA); Mental Capacity Act and refreshers; Record keeping; Fire Precaution training for all staff and appointed fire marshals and Impact Assessment training for managers. Staff are also encouraged to access ‘Skills for Life’ Literacy and Numeracy sessions. We noted that information about staff training needs was well managed and assisted in making sure that staff attended and received the training they needed. The system also alerts the managers when refreshers and updates for courses such as Food Hygiene, First Aid and Moving and Handling are needed. We found that staff went through a thorough induction process. The Induction Course is nine days long. The programme is designed to prepare staff for supporting people with complex communication needs, and there is a heavy emphasis on Autism Awareness, communication and Behaviour Management. Other topics covered includes: Manual handling Training; Residential Life and the Sea Shell Trust Statement of Purpose; Health and Safety; Personal care; Audiology; Students Rights; POVA and Person Centred Planning. We received surveys from nine staff and all felt that the induction training prepared them ‘very well’ for the job. We found that the staffing level for each person is dependant on the needs assessed by the placing authority and the Sea Shell Trust assessment. Some people have two members of staff at all times, others one and others have hours allocated to them although everyone has a 24 hour service. In the information returned to us the manager confirmed that over 50 of care staff had attained National Vocational Qualification (NVQ) level 2 or above. She also stated ‘The Professional Development Centre have employed an additional full time trainer, we have 5 additional NVQ 3 assessors. We have access to a NVQ trainer on nights to allow night workers to complete their NVQ’s in care during working hours.’ Staff highlighted training as one of the benefits of working for the organisation. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 26 Some staff who returned surveys commented that they were sometimes moved around the units. We discussed staffing with the management team who said that this occurs when people go off sick at short notice and that senior staff are rarely moved. We noted that the staff teams appeared to be made up of a high proportion of young adults, this means that they may have an affinity with the people they were supporting. We noted from the information returned to us that there is a high turnover of staff. We discussed this with the manager who informed us that this was always amongst the junior and younger members staff. And that this was a result of them achieving their National Vocational Qualifications and then taking up promotions and going on to further education. She also said that they often worked as bank staff and returned over the holiday periods. The manager stated that in the past year only one senior staff had left the service because of relocation. We found that people were in the main enthusiastic about working for the Sea Shell Trust and they told us: ‘A lot of staff support is in place, training, debriefing, supervision, an open door policy in the care suite and support from outside organisations.’ And staff said that the adult literacy and numeracy course was: ‘…. especially beneficial because of the amount of paperwork that we have to do.’ The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Students living at Sea Shell Trust benefit from a service that is managed in a manner which promotes improvements and peoples general wellbeing. EVIDENCE: The manager is a qualified nurse and social worker and confirmed that she remained registered with the General Social care council, and staff said that support was available and effective. We noted that she attended meetings, conferences and training in relation to her role. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 28 We saw that the service operates a policy by which the head of care announces spot checks in each of the units. During the checks they comment on the quality of care plans and whether they are up to date and well written. They look at the incidence books and whether issues have been signed off as been brought to the attention of the manager. They look at whether risk assessments have been completed and updated. The service manager also checks complaints that have been recorded and how these have been dealt with. They check that activities tables are in place for each person and that the format is accessible to that person. They also check for evidence that people have carried the planned factitively. The manager also looks at staff interaction with the student. And they look at the environment and medication records. We found that the quality assurance questionnaire packs have been sent to relatives, students and people concerned with the service, these packs include questions about the residential side of the service. The questionnaires returned from last year will be published in 2009. The manager confirmed that what people said would be analysed and used to inform the organisations yearly action plan. In relation to quality assurance the manager told us that the organisation holds ‘Monthly house staff meetings where staff have the opportunity and are encouraged to feedback their views and opinions’. We looked at the records of these meetings and found that topics included food and diet, budgeting, policies and procedures, planning and discussing ideas for activities with students and rotas. We looked at the policy and procedures concerning resident’s monies. We found that this doe not include guidance about the use of personal identification numbers (PINs). We asked the manager to have this policy updated so that staff know what is expected of them in relation to this. We looked at the maintenance record for each unit and these were in the main up-to-date and demonstrated that risk assessments, fire safety plans, electricity checks, gas checks, equipment servicing and general maintenance was completed. The Sea Shell Trust organisation employs a team of five maintenance staff. We saw records that confirmed that staff had received health and safety training, food hygiene, infection control, moving and handling training and First Aid training. This indicates that staff should have the necessary skills and information to promote peoples safety and wellbeing. The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000073259.V376835.R01.S.doc 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Version 5.2 Page 30 The Seashell Trust - The Royal College Manchester No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations The registered person should ensure that all medication is monitored more carefully and that staff that are responsible for giving it out are fully involved in checking in medication so that the information on each unit includes the amounts of medication. This will help staff to audit whether medication has been given in keeping with the prescription and errors can be noticed more quickly. The registered person should speed up the refurbishment of the units and plans for decoration, particularly on the Orchard unit. They need to take further steps to ensure that all the furniture fittings, adaptations, decoration and equipment are domestic in nature and in good repair on all units. This will demonstrate that the organisation recognises the benefits of living a pleasant environment. 2 YA24 The Seashell Trust - The Royal College Manchester DS0000073259.V376835.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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