Care Home: The Summers

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What the care home does well The building`s design promotes small group living where people using services can maximise their independence in a non-institutional setting. The home is suitably equipped for its stated purpose, enabling people using services to live in a clean, safe, generally well-maintained and comfortable environment. Policies and procedures promote equality and diversity and non-discriminatory practice. People considering using this service and their advocates have access to information enabling an informed choice of home. They receive a comprehensive needs assessment before admission, ensuring individual needs, expectations and aspirations can be met. The approach to care planning is person-centred and the privacy and dignity of people using services is respected by staff. Health is promoted and access to primary and specialist health services facilitated in accordance with need. The home has a sustained record of full compliance with regulations governing the management of medication. Menus are varied, affording choice of food and ensure dietary needs are met. People using services engage in meaningful daytime activities of their choice in accordance with their diverse needs and capabilities.Staff are suitably trained and in sufficient numbers. They demonstrate understanding and apply `best practice` principles in their delivery of care and support. Those on duty during the visit interacted with people using services in an age appropriate way, addressing them in a friendly, respectful manner, using known and preferred names. They were aware of the individual needs and preferences of the people they supported. People using services and their advocates are able to express their views and any concerns in a safe, understanding environment. They have access to an effective complaint procedure and robust policies and procedures safeguard people using services from abuse and neglect. Comments received during the inspection included, " I`ve been coming her for short stays for years. I`m very satisfied with everything, staff are nice, food is good and my room is comfortable". " I have lived here for six years and have my own bank account. Staff go with me to the bank to withdraw my money and help me spend it on what I like. The staff are all good at listening to me so that I do what I want to do. I like to go to bed at about seven thirty and to spend time in my room on my own. I can watch television from my bed or listen to music". " I live here with my wife, we decided not to go away on holiday this year but have gone on outings". " I had a holiday last year and I`m booked to go again later in the year." What has improved since the last inspection? Consistency of the same manager at the home since the last inspection has had a positive impact on its management and operation. Staff feedback indicated the management team provided staff with effective leadership and direction. A senior care assistant commented, "The manager is very good, approachable, fair and supportive". A warm atmosphere was observed throughout the visit and positive relationships were evident between individual members of staff and people using services. Owing to a planned change in the home`s ownership the staff team is depleted in numbers as vacant posts of staff who have left have not been filled since 2007. Staffing levels have been consistently maintained using agency staff. Since the last inspection a change in contractual arrangements for engaging agency staff and monitoring their vetting and training was disruptive to services, for a period of time. This change generated significant turn - over in agency workers. Long - term agency workers, some of whom had worked at the home for many years were unable to continue to do so. Though some respite users reported this change did adversely affect them as new agency workers did not all have an understanding of their needs and capabilities, the majority of people permanently placed at the home said they were not unduly affected. The home`s management emphasised every effort is made to use regular agency staff, where possible. Comments from people using services included, "My key worker is excellent. You can`t fault him. He`s known me for ten years. He is such a hard worker and on the ball. All the staff are very good. Though some might say different I find all the agency staff very good as well. The staff can sometimes have their off days but so do we all." "I have a very close relationship with all the staff". A new quality audit form has been implemented, strengthening existing quality assurance systems. The views of people using services are sought during the home`s self-monitoring activities. This form is issued to people using respite services after each stay and completed by other people using this service twice a year. Other improvements are in areas of building maintenance, health and safety and fire safety and staff Fire Marshals are a further new development. There has been increased focus on staff training and development, on risk assessments and on induction procedures for agency staff new to the home. A reported improvement in staff absence rates has had positive benefits for people using services, enabling their social care needs and aspirations to be met. Opportunities for social inclusion have also been enhanced by regular access to a suitable vehicle and driver, a more individualised approach to social care activities and a new initiative enabling some wheelchair users to use public transport. What the care home could do better: The home has not had a registered manager since December 2007. A requirement has been made for a manager to be appointed and submit an application for registration. This will enable people using services to be confident their needs are met by a home managed by an appropriate person. The ratio of staff to people using services was under review at the time of this inspection. The proposed new staffing structure and reduced staffing levels was evidently of major concern to staff consulted and some people using services. Individuals` were also anxious about the long -term future of the home`s services and low occupancy levels. A requirement has been made for reports to be produced after all statutory monthly visits carried out by the organisation`s designated responsible individual and available in the home, for inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: The Summers Yeend Close West Molesey Surrey KT8 2NA     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: Patricia Collins     Date: 1 1 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: The Summers Yeend Close West Molesey Surrey KT8 2NA 02089794689 02089410468 AndyWinter@kwymca.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kingston & Wimbledon YMCA care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 28. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - (PD) Physical disability, over 65 years of age - (PD(E)) - 5 Learning disability - (LD) - 4 Mental disorder, excluding learning disability or dementia - (MD) - 1 Dementia - (DE) 1 Date of last inspection Brief description of the care home The Summers is a care home registered to provide personal care and accommodation for up to 28 adults of either gender whose primary care needs on admission are with the categories of Physical Disabilities or Learning Disabilities. Service provision is for permanent and respite care. The home is within walking distance of shops and close to all community facilities. The property is a detached, two-storey building with one passenger lift. There is a secluded garden area and car parking spaces.The service provides a good standard of accommodation, equipped to comply with disability and Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 28 28 2 7 0 9 2 0 0 8 Brief description of the care home national minimum standards for adults. The 28 bed sitting rooms are grouped into four flats, with their own communal lounges, dining and kitchenette facilities, wheelchair accessible toilets and assisted bathrooms. Kingston and Wimbledon YMCA owns and manages the service and staff are employed by Surrey County Council. Weekly fee charges are 1051 pounds 88 pence. Care Homes for Adults (18-65 years) Page 5 of 33 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: Date of last key inspection: 27th September 2008. This unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was carried out by one inspector over two days and a period of seven hours. Both visits were facilitated by the person with a designated management role.The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgements about how well the service is meeting the National Minimum Standards (NMS) for Adults. This includes accumulated evidence, knowledge and experience of the home since its last key inspection. Also feedback received in survey questionnaires from seven people using this service, four relatives, one health professional and four staff. Care Homes for Adults (18-65 years) Page 6 of 33 Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. The AQAA provides quantitative and some numerical information about their service. It requires assessment of the homes services against NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time, its content was clear and validated by evidence.This information also informed service judgements. The inspection process included viewing all communal areas, sampling bedrooms, toilets and bathrooms in the two living units currently operational. We also viewed the garden and gathered information during in depth discussions with four people using services. We had contact and discussions with most people using services and a number of staff. Documents sampled included the homes statement of purpose and service users guide, care plans, needs and risk assessments and records relating to care, social activities and finances. We sampled procedures for ensuring agency staff are vetted and trained and the training records of permanent staff. We also sampled staff rotas, complaint and safeguarding procedures, recent quality assurance surveys and reports of statutory visits carried out on behalf of the provider organisation. We examined menus, observed lunch and an evening meal and looked at medication practice, storage and record keeping. Areas discussed with the person designated fit to manage the home by the responsible individual, referred to in the report as the manager, included a proposed change in staffing levels, arrangements for building maintenance and management supervision and support. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? Consistency of the same manager at the home since the last inspection has had a positive impact on its management and operation. Staff feedback indicated the management team provided staff with effective leadership and direction. A senior care assistant commented, The manager is very good, approachable, fair and supportive. A warm atmosphere was observed throughout the visit and positive relationships were evident between individual members of staff and people using services. Owing to a planned change in the homes ownership the staff team is depleted in numbers as vacant posts of staff who have left have not been filled since 2007. Staffing levels have been consistently maintained using agency staff. Since the last inspection a change in contractual arrangements for engaging agency staff and monitoring their vetting and training was disruptive to services, for a period of time. This change generated Care Homes for Adults (18-65 years) Page 8 of 33 significant turn - over in agency workers. Long - term agency workers, some of whom had worked at the home for many years were unable to continue to do so. Though some respite users reported this change did adversely affect them as new agency workers did not all have an understanding of their needs and capabilities, the majority of people permanently placed at the home said they were not unduly affected. The homes management emphasised every effort is made to use regular agency staff, where possible. Comments from people using services included, My key worker is excellent. You cant fault him. Hes known me for ten years. He is such a hard worker and on the ball. All the staff are very good. Though some might say different I find all the agency staff very good as well. The staff can sometimes have their off days but so do we all. I have a very close relationship with all the staff. A new quality audit form has been implemented, strengthening existing quality assurance systems. The views of people using services are sought during the homes self-monitoring activities. This form is issued to people using respite services after each stay and completed by other people using this service twice a year. Other improvements are in areas of building maintenance, health and safety and fire safety and staff Fire Marshals are a further new development. There has been increased focus on staff training and development, on risk assessments and on induction procedures for agency staff new to the home. A reported improvement in staff absence rates has had positive benefits for people using services, enabling their social care needs and aspirations to be met. Opportunities for social inclusion have also been enhanced by regular access to a suitable vehicle and driver, a more individualised approach to social care activities and a new initiative enabling some wheelchair users to use public transport. 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 9 of 33 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 10 of 33 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 may use the service and their representatives have the information they need to choose a home that will meet their needs. They can be assured their needs can be met on the basis of comprehensive needs assessments carried out before admission. Evidence: The homes management understands the importance of having sufficient information when choosing a care home. A comprehensive statement of purpose and service users guide has been produced specific to the user group, to help people make an informed choice of home.These documents contain all statutory information, setting out the homes aims and objectives, care philosophy, its services and facilities and providing information about fees and additional charges. A minor amendment is necessary to these documents to reflect a further change of contact details for the Care Quality Commission (CQC).Whilst these documents are not in formats using symbols or easy read language to meet the communication needs of all people using this service, key workers are responsible for supporting their understanding, promoting opportunity for discussion and clarification. We were informed by management that all people using Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: services have a personal copy of the service users guide.The service users guide describes the provider organisation as a Christian movement that welcomes into its fellowship people of other religious faiths and those of none. There is a statement that the organisation is committed to equality of opportunities for people using services and staff. This means people will be treated fairly regardless of their race, colour, age, gender, disability or sexual orientation. All the policies and procedures are stated to support this and the organisation will act in accordance with equality legislation. The homes admission criteria ensures equality of access to services. Since the decision for a change in ownership admissions have been suspended since 2007, other than respite services. At the time of the visit there were nine people using services which included one person admitted for respite care. For this reason the two first floor living units were not operational.Though respite services continue to be available for the seven people living in the community using the same, this service has been disrupted by the proposed change in ownership. Respite users are no longer able to book their stay in advance and a relative stated this factor was adversely affected her life as she is unable to plan a holiday. She also expressed concerns about the continuing uncertainty about the long-term future of respite services. A respite user commented, The Summers needs urgently to have its future consolidated. Not knowing what is happening is demoralising to all concerned. It could be good, very good, at present its dying on its feet. We viewed the records of two people permanently placed at the home and of one person receiving respite services. It was evident that admission decisions are based on the outcome of comprehensive needs assessments to ensure needs can be met. These assessments take account of multidisciplinary reports, including health needs assessments and clinical information. The assessments focus on achieving positive outcomes and support involvement of prospective people using services in this process. Much of the assessment information is gathered prior to admission for people referred for permanent placements. Following admission, the assessment process continues over a twelve week period, with a review half way for any necessary adjustment to care plans.Respite placements are reviewed after each placement. The home no longer accepts referrals for emergency admissions. Care Homes for Adults (18-65 years) Page 12 of 33 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. People who use this service are actively involved in planning their care and support and their independence is promoted. Evidence: The home supports individuals with a range of needs, including complex health needs. Records indicate a consistent approach to meeting needs and supporting people in further developing independent living skills and social skills, within individual capabilities. Key workers meet regularly with the people they support and maintain monthly written summaries of their activities. People using services are encouraged to be involved in decisions about various aspects of the day-to-day operation of their home and attend regular meetings with management.They are informed of the proposed change in the homes ownership. Information in three care plans and associated care records, survey feedback and from discussions with people using services and staff informed judgements about the level of control people using services have in their lives. They were observed to be involved in directing their individualised services. The care plans viewed were holistic and Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: based on needs and risk assessments with reference to equality and diversity needs. They included information about how people wish to be addressed, individual methods of communication, of people significant in their lives and how they choose and prefer to receive personal care and support. Routines are reasonably flexible and individuals interests are known and recorded. There is a choice of meals, holidays and outings, social and leisure activities in the community and in the home. People using services decide how they spend their time, when they go to bed and get up, choose their personal clothing and hairstyles and what they spend their money on. Independence is encouraged within a risk management framework. People using services are offered keys to their bedrooms and staff were observed to respect their privacy. Consent was sought from people using services before viewing their rooms. One individual gave us the key to view his room and we found his room to be personalised, reflecting his interests and personal choices. Staff had supported him in purchasing a fridge for his room in which he prefers to store his canned drinks. Staff respect this individuals choice to have a dining table to himself at mealtimes. People using services are consulted regularly to assess levels of satisfaction with services. In addition to quality review surveys, which is a new development, this is achieved through their meetings with the homes management and external management. Comments received during the visit included, Ive been coming her for short stays for years. Im very satisfied with everything, staff are nice, food is good and my room is comfortable. I have lived here for six years and have my own bank account. Staff go with me to the bank to withdraw my money and help me spend it on what I like. The staff are all good at listening to me so that I do what I want to do. I like to go to bed at about seven thirty and to spend time in my room on my own. I can watch television from my bed or listen to music. I live here with my wife, we decided not to go away on holiday this year but have gone on outings. I had a holiday last year and Im booked to go again later in the year. In response to our survey relatives commented, My relative used to receive respite care at The Summers for many years.I felt staff looked after him very well and met his needs. He needed continuity of staffing because of his needs affecting speech which The Summers provided. Staff made the place homely and residents feel at ease. They were part of the local community by just being taken to buy a daily newspaper from the shops. There are few homes specialising in physical disability services and I feel The Summers is unique and very much appreciated. I am thankful for the services that The Summers gave us during the many years my relative received respite services.The Summers has always been part of the community in Molesey. If they wished to the residents would be taken to the local day centre also run by Surrey County Council. They therefore felt they were not locked away. I always felt safe when I left my relative in their care. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: My relative has for many years received respite care at The Summers. He has had excellent care. The manager and staff have always made him very welcome and he is happy whilst there. He meets many of the staff when out locally. I have been very well served by the help and support given to my relative when respite care was needed in an emergency. Care Homes for Adults (18-65 years) Page 15 of 33 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 using this service are offered a healthy diet. They participate in age, peer and culturally appropriate activities and are part of their local community. They are able to make choices about their lifestyle and are supported in developing life skills, within individual levels of capability. Evidence: Staff were observed frequently interacting with people using services throughout the visit in an age-appropriate, friendly and respectful manner, providing good levels of social stimulation. They support individuals in maintaining relationships with relatives and friends. Some individuals visit their relatives homes and visitors were stated to be made welcome.There is a guest room and families and friends of people using services can stay overnight and are welcome to stay for meals. Central to the homes aims and objectives is the promotion of the rights of people using services to live meaningful, fulfilling lives appropriate to their age and culture; also to be part of their community, Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: enjoying the rights and responsibilities of citizenship. Records demonstrated consultation with people using services to ensure an individualised approach to meeting lifestyle aspirations, ensuring community participation and taking account of age, disability, interests and culture. Photographs were displayed in the entrance hall of the homes annual summer BBQ event. It was evident this had been a very enjoyable occasion attended by relatives and friends of people using services. Complimentary cards in the home were viewed from relatives and friends thanking the team for their hard work and continuing high standard of care and support. Social activities at the home include fortnightly bingo sessions with prizes also a weekly take- away supper and film evening. Excursions recently enjoyed included trips to the coast, Birdsworld, a farm, on a canal boat, shopping, an exhibition and theatre. Staff support people in the use of pubs and in going out and about in the local area. Activity equipment includes televisions and music systems, a karaoke system, organ, various boardgames, crosswords and playing cards. Individuals have allocated one to one time with staff for manicures, talking with staff and listening to music. One person attends a day centre five days a week. Another individual attends a day centre twice a week and also enjoys using a gym at a leisure centre twice a week, with staff support. Though staffing levels and high use of agency staff has not changed since the last inspection, the majority of people using services were significantly more satisfied than previously with arrangements for social activities and community engagement. The manager credited this improvement to a combination of factors. These included reduction in staff absences which had previously disrupted planned community activities. Also consistent access to a mini bus and driver twice a week. The activities organiser, who is a long-term agency worker and was on leave at the time of the visit, had worked closely with staff on developing a more individualised approach to meeting social care needs. Since joining the Molesey Residents Association, which is a new development, staff are more aware of local social opportunities. Some individuals now use wheelchair accessible public transport, with staff support. Comments from people using services included, Staff come with me on the bus but it only takes one wheelchair so me and my wife dont go together. Use of the bus has made a big difference to our lives though. I go with my key worker or other staff , if they are too busy I say okay, well go another day. I am a respite user. The Summers meets my every need. Excellent service. Could do better by providing more activities for residents and short term stayers. I am an outdoors person but I hardly get staff to take me out, not as often as I like. The manager was requested to review the activities programme of this individual. Each living unit has a small kitchenette and people using services can, with staff support, prepare drinks, light meals or snacks, whenever they wish. They may also choose to invite other people using services to their flat for a meal or visitors.Dining Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: furniture is wheelchair accessible and people using services are assisted to choose appropriate eating aids. Staff practice at meal times was observed to respect the dignity and ensure the safety of people requiring assistance with eating.The mealtimes viewed were social, relaxed occasions with frequent friendly interaction between staff and people using services. A head cook and assistant cook work daily on the early shift, sometimes working together. On other days a part-time kitchen assistant supports them. Food is transported to the the living units in heated trolleys from the commercial on-site kitchen. The kitchen has been awarded a 5 star food hygiene rating by the Environmental Health Department since the last inspection. The assistant cook on duty on the day of the inspection visit stated most kitchen equipment was functional with the exception of an electric food mixer. The manager confirmed plans for replacement of the mixer. Menus sampled offered a varied diet and were produced one week in advance, in partnership with people using services. Each day their choice of meals is assured through the practice of staff confirming their choices from the days menu. If an alternative to the choices on the menu is preferred this is recorded and the cook prepares what they would like. The two course meal observed at the time of the visit was substantial and nicely presented. Dietary and personal food preferences were being met. Care Homes for Adults (18-65 years) Page 18 of 33 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 health and personal care people using service receive is based on their individual needs and preferences. Principles of respect, dignity and privacy are put into practice and medication procedures are safe. Evidence: Observations during the visit confirmed good care and attention given to the personal appearance of people using services. They were supported to dress appropriate to their age and culture and in accordance with personal choice. A person using service commented, There have been a lot of change in staff, particularly new agency staff but in my view they are as good as permanent staff. I have a very close relationships with all the staff. I am clear with new staff that they must see beyond my illness and recognise and treat me as a unique person, and they do. I have no problems here. Survey feedback from a person using respite services however confirmed this persons experience that more continuity of carers would increase their knowledge and understanding of this individuals capabilities and needs. Baseline assessments and review processes promote good health and ensure necessary equipment is purchased to meet individual needs. This includes equipment for pressure sore prevention, moving and handling with overhead tracking, specialist bathing equipment and Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: suitable furniture. Wheelchairs are individually fitted and wheelchair storage and recharging facilities are in a separate area. Care plans are detailed, recording personal preferences for meeting personal and healthcare needs and reflect current health and personal care objectives. These are reviewed at least six monthly and care management reviews take place annually for the majority of people permanently placed at the home.Risk assessments provide governance, within a multi-disciplinary framework, for appropriate and safe use of bed-rails and wheelchair lap-straps. Discussions with the manager included the need to ensure weights are regularily monitored to ensure a timely response to significant loss or gain in weight. People using services are all registered with a general practitioner (GP). They usually see their GP at the medical practice though home visits can be requested. An individualised approach to health screening was evident, identifying changes in health status and meeting healthcare needs. Records demonstrated regular input from opthalmic, podiatry and dentist/dental hygienist services. Two people were stated to use a private chiropodist which they pay for themselves. The home is efficient at ensuring multi-disciplinary professional assessment, treatment and monitoring of health conditions. Effective infection control arrangements are in place and for management of incontinence. Staff stated they received good support from all health professionals including the district nursing service. A multi-disciplinary approach to pressure sore prevention was noted. A health professional informed us that usually the homes assessment arrangements ensure accurate information is gathered so that appropriate services can be planned for each individual. Staff were stated to seek and act on professional advice and to always respect the privacy and dignity of people using services. This professional commented, Staff are always approachable, friendly and helpful, though sometimes a little slow to respond to requests and messages dont always get passed on. The same professional said the home usually administers and manages medication correctly.The GP carries out six-monthly medication reviews. Staff adhere to an efficient medication policy, procedure and practice guidance, produced by Surrey County Council. We looked at the management and storage of medication during the visit and sampled the medication records of three people using services. The home has a sustained record of full compliance with regulations governing medication. No controlled drugs were prescribed and the management of medication was found to be satisfactory.The pharmacy supplying medication to the home also undertakes regular medication audits. A necessary change to recording practice, at the time of the last audit, had been implemented. None of the people permanently placed at the home are assessed as having capacity to self-medicate. Independence is promoted by encouraging self-medication, if safe.This was evidenced from the records of a person using the respite service. A medication risk assessment is carried out for this individual on the first day of each respite period. We discussed Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: feedback from another respite user who was unable to self-medicate whilst at the home from a dosset box prepared by her carer before admission. This is because staff are unable to verify the medication dispensed by the carer. This can be overcome if the carer, in advance of her respite stay, requests a pharmacy to dispense her medication in a monitored dosage pack. Staff will then be able to check in the medication in accordance with the homes procedures. This was discussed with the manager who agreed to follow up with the family concerned. Staff had received medication training which the manager said included a practice assessment. Regular refresher medication training is arranged for permanent staff. Though some agency staff have had medication training the homes policy is for only permanent staff to administer medication. Care Homes for Adults (18-65 years) Page 21 of 33 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. There is a clear and effective complaint procedure and the views of people using services are listened to and acted upon. Policies and procedures safeguard people using services from abuse and respect their rights. Evidence: The homes complaints and protection procedures reflect the needs of people under the six strands of diversity. The service users guide contains information about how to make a complaint. The need to update the complaint procedure with the latest contact details for the Care Quality Commission (CQC) was discussed. The complaint procedure had been reviewed since the last inspection and a new procedure produced. It was understood this had been made available to people using services and other stakeholder and staff had been trained in the new procedure. The homes records indicated no complaints had been received by the home in the past twelve months. Surrey County Councils complaint monitoring system does not include complaints resolved within 24 hours of receipt. The manager confirmed these complaints would be documented in care notes. All people using services who responded to our survey were aware of the complaint procedure and most knew who to tell if they had a complaint or concern. Discussions with people using services confirmed they feel safe and comfortable in making a complaint and being open with their views at their meetings. They said the homes management responds to concerns or complaints they may have and staff treat them well. A respite user said, I would go upstairs and see the manager if I had a complaint. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Policies and procedures for safeguarding adults are available in the home, giving clear specific guidance to staff. These ensure allegations or suspicions of abuse or neglect are investigated in accordance with local and multi-agency safeguarding procedures. A system exists for staff to report concerns about colleagues and managers.No safeguarding referrals had been received involving the home since the last inspection. Staff including agency workers have had safeguarding adults training. Staff recruitment and vetting procedures for all staff working at the home include a system for verifying their identity, qualifications and training. Observations indicate the human rights of people using this service are respected. The manager, an assistant team manager and two staff are booked to attend a training event relating to the homes assessment obligations under the Mental Capacity Act. Policies and practices for the management of the personal finances of people using services ensure their money is secure and records are maintained. People using services have access to their rooms at all times and freely use the wider environment of their home. If they wish to go out staff will facilitate this, even if they only have time to go for a walk locally. Staff consulted understood what restraint is. Equipment which may restrain individuals, for example, bed-rails and lap belts are only used when necessary and based on assessment of needs and risks. A conversation with a wheelchair user confirmed use of a lap strap at all times, for safety reasons, was with her informed consent. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes physical design and layout enables people using services to live in a safe, well-maintained, clean and comfortable environment that promotes independence. Evidence: The home was purpose built in 1997 and is fully wheelchair accessible, incorporating design principles appropriate to its stated purpose. The building is equipped to maximise independence, with electric hoists as standard and hoist-tracking equipment provided in bathrooms and bedrooms. First floor accommodation and facilities are accessible by passenger lift. Car parking facilities are available at the front of the premises. Living accommodation is divided into four flats, two on each floor. These provide all single occupancy bed-sitting rooms, spacious combined lounge and dining rooms for communal use with kitchenette facilities, assisted toilet and bathing facilities. Observations confirmed an overall good standard of accommodation with quality furnishings and specialist equipment specific to the individual needs of people using services. The four bedrooms viewed with the consent of their occupants were comfortably furnished and most personalised, reflecting their tastes and interests. The bedroom used for a person on respite care could be improved by provision of pictures to create a more homely environment. Bedrooms each have a washbasin, lockable storage and private telephone lines. The ground floor flats have doors opening out Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: onto a small, private garden area and the two upstairs flats have balconies. External lighting is available in the garden, which was neat and tidy at the time of the visit, maintained by a gardener employed by the YMCA. Bushes and hedges have been cleared this year, opening up the garden area and improving wheelchair access.Night staff were stated to ensure gates leading from the garden to the front of the home, open at the time of the visit, are secured at night. The home has a suitably equipped laundry room. A significant recent change has been the retirement of a domestic and laundry assistant in addition to a care assistant. The remaining part-time laundry worker has increased her hours to enable the laundry service to continue at full capacity. A part-time carer has also increased her hours to be able to undertake domestic work three morning a week. Use of agency cleaners two morning a week for deep cleaning tasks has also been agreed. Care staff have a generic role and are expected to undertake cleaning tasks as part of their duties. At the time of the visit the home was clean and hygienic. Difficulties and delays since the last inspection in arranging building maintenance was said to have been overcome since the employment of a maintenance worker by the YMCA. At the time of the visit a bathroom in Flat 2 could not be used, pending the replacement of a door removed for repair by the maintenance worker. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained, skilled and in sufficient numbers to flexibly meet the needs and lifestyle aspirations of people using this service. The policies and procedures of the home ensure staff recruitment practice is safe. Evidence: A warm atmosphere was observed throughout the visit. People using services were very positive in their feedback about staff. Comments included, My key worker is excellent. You cant fault him. Hes known me for ten years. He is such a hard worker and on the ball. All the staff are very good. Though some might say different I find all the agency staff very good as well. The staff can sometimes have their off days but so do we all. I have a very close relationship with all the staff. With the exception of the gardener and maintenance person the home is staffed by employees of Surrey County Council. They are managed by Surrey Adult and Community Services, in accordance with existing contractual arrangement.Since 2007 staff who have left have not been replaced due to a planned change in the homes ownership. Staffing levels have been maintained through use of agency workers. Five staff were noted to have left or retired since the last inspection. On the basis that no new permanent staff have been employed recruitment and vetting practice for Surrey Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: County Council employees was not inspected on this occasion. We received written confirmation in the past of compliance with regulations relating to staff recruitment from the responsible individual. Since the last inspection Surrey County Council has contracted with a different organisation who is responsible for ensuring agencies approved to supply staff to the home follow robust vetting and training procedures before staff work at the home. As a result of this change of contract, a number of agency workers who had worked at the home for many years are no longer used.Discussions with people using services at the time of the visit confirmed that from their perspective this had not adversely affected them. However this view was not shared by a number of people using the respite service. An assistant team manager completes a first day check list for all new agency staff on their arrival at the home. They are required to produce documentation evidencing identity, training and vetting, including a current Criminal Record Bureau disclosure (CRB). The training record sampled of an agency worker was not complete and did not reflect all the mandatory and other training this worker stated he undertaken. The manager agreed to ensure these records are maintained up to date. A recent development has been the production of an induction pack for agency workers. An indepth discussion with an agency worker established the induction he received informed him of emergency and fire procedures and other relevant policies and procedures. Initially he had worked with a permanent, experienced member of staff. This ensured safe practice and delivery of care and support in accordance with care plans and the preferences of people using services. He had been afforded time to familiarise himself with care files, enabling good understanding of the diversity and needs of the people using services. The service provides a high staff ratio to people using services, supporting their needs, activities and aspirations in an individualised and person centred way. At the time of this inspection staffing levels were under review and a new staffing structure proposed reducing staffing levels on day and night duty. This will impact on shift leaders and managers, increasing their direct involvement in care and support practice. Staff, some people using services and relatives expressed anxiety about the safety of the proposed reduced staffing levels. The responsible individual on behalf of the YMCA is involved in this staffing review to ensure the home is staffed efficiently. Jointly with Surrey County Council creative ways of making sure the home is staffed efficiently without adversely impacting on service quality is planned. Records sampled at the time of the visit confirmed an ongoing staff training and development programme. More than 50 of permanent care workers have qualifications in care or health and social care at the minimum level, or above. Care Homes for Adults (18-65 years) Page 27 of 33 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. People using services benefit from an overall well run home in which their health, safety and welfare is promoted and protected. A manager must be appointed and submit an application for registration, so that people using services can be confident the home is managed by an appropriate person.Quality monitoring and quality assurance systems seek the views of people using. Evidence: The changes in ownership planned at the time of the last inspection did not take place. At the time of the inspection visit we were informed that negotiations were in progress with a new purchaser. The circumstances of the homes pending sale over several years has led to the failure to appoint and register a home manager since the former registered managers resignation in December 2007. Because an application for the homes re-registration has not been received from a new provider a requirement has been made for a home manager to be appointed and to submit an application for registration. The employee in the role of home manager for the past eighteen months has relevant Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: experience and a health and social care qualification. She intends to study for a health and social care management qualification. Continuity of the same person in the role of manager has brought stability to the home. The management structure includes two assistant team managers, one of whom has worked at the home for a number of years. The agency team manager is new in post since the last inspection. The management team appeared cohesive and clear of individual roles and responsibilities. Individual staff said they were well supported by the homes managers though less so by Surrey County Council, their employer. A senior care assistant commented, The home manager is very good, approachable, fair and supportive. The person in the role of home manager reported recent improvement in her line management support. Risk assessment processes involve people using services, underpin care plans, practice and routines. Observations confirmed an understanding and application of best practice management systems and awareness of equality and diversity policies and procedures. An administrator ensures office systems and record keeping is organised and policies and procedures have been updated since the last inspection.Communication systems appear to work well and effective systems safeguard the personal finances and valuables of people using services. The homes annual quality assurance assessment (AQAA) contained relevant information validated by evidence. It demonstrated self-awareness of areas for further development and how this could be achieved. Delays with building maintenance and repairs had been largely overcome since a YMCA employee had been delegated this responsibility. The staff training programme supports safe working practices. Records demonstrate regular audit and maintenance of health and safety and fire safety systems and equipment. Fire Marshals are a new development and regular fire drills and fire tests are carried out. The homes fire evacuation plan had been updated. Quality assurance and quality monitoring systems include seeking the views of people using services. A new quality audit form had been produced for this purpose. This is issued to people using respite services after each stay and it is proposed to survey the views of people permanently placed at the home twice a year. The latest survey carried out in March this year confirmed an overall good level of satisfaction with services. The homes management had acted on and resolved a concern raised by one individual. The responsible individual on behalf of the YMCA was stated to carry out monthly statutory visits to the home. Only four reports generated from these visits could be found however. A requirement has been made for compliance by ensuring reports of all statutory visits are generated and available in the home. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 37 9 The registered person must 06/01/2010 ensure a manager is appointed and submits an application for registration to to the Care Quality Commission. This will enable people using services to be confident their needs are met because the home is managed by an appropriate person. 2 39 26 Statutory visits on behalf of 13/11/2009 the organisation must take place at least once a month and a written report of these visits prepared and supplied to the manager and be available for inspection. This will ensure monthly monitoring of the conduct of the home where the provider is not in day to day charge, ensuring it runs in the best interest of people using this service. Care Homes for Adults (18-65 years) Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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