Care Home: The Tidings

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What the care home does well People living in the home told us that staff listened to them and helped them to do things that they wanted to do.Evidence that we looked at showed that people`s health needs were being met. The service worked closely with people to help them stay in contact with important family members.The service was good at supporting people to get out and do lots of activities that they enjoyed.The home had comfortable rooms for people to live in and people`s personal rooms were also comfortable and had their own things around them. What has improved since the last inspection? All staff are now receiving the training that they need to help them to make sure people are kept safe. What the care home could do better: The service needs to continue to develop its paperwork and recording, and continue to build upon its current good practice. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Tidings The Tidings 9 Brewery Drive Halstead Essex CO9 1BS The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Neal Cranmer Date: 0 4 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: The Tidings The Tidings 9 Brewery Drive Halstead Essex CO9 1BS 01787473198 F/P01787473198 aysheahutchinson@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Isabel Mabhena care home 2 Number of places (if applicable): Under 65 Over 65 2 0 learning disability Additional conditions: Date of last inspection A bit about the care home The Tidings is a small house situated in the heart of Halstead in Essex, close to local amenities. Care Homes for Adults (18-65 years) Page 4 of 30 The home accommodates two ladies, who are supported by a small staff team to live as independently as possible. The property comprises of three bedrooms, a small communal lounge, kitchen dinning room. Patio doors lead from the lounge to a small-enclosed garden area, laid mostly to lawn. Fees for staying in the home are between £750.00-£1.800.00 per week, there was no mention of any additional charges being made, this information was provided on the day of the inspection by the proprietor. Care Homes for Adults (18-65 years) Page 5 of 30 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 Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home We visited the home on the 4th August 2009. During our visit we looked at lots of different evidence to help us write this report, this evidence included looking at paperwork like care plans and staff files. We also spent time looking around the home and talked to people living in the home and some of the staff working there. We also spoke with the manager who is responsible for the support people get. We looked to see if people were happy with what was going on in the home What the care home does well People living in the home told us that staff listened to them and helped them to do things that they wanted to do. Care Homes for Adults (18-65 years) Page 7 of 30 Evidence that we looked at showed that peoples health needs were being met. The service worked closely with people to help them stay in contact with important family members. The service was good at supporting people to get out and do lots of activities that they enjoyed. The home had comfortable rooms for people to live in and peoples personal rooms were also comfortable and had their own things around them. Care Homes for Adults (18-65 years) Page 8 of 30 What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 9 of 30 If you want to speak to the inspector please contact Neal Cranmer CQc East City Gate Gallowgate Newcastle-Upon-Tyne NE1 4PA 030006161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 of 30 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 11 of 30 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 looking to live in the home can expect to be provided with the necessary information to enable them or their representatives to decide if the home will be able to meet their assessed needs. Evidence: The home has a document called the Statement of Purpose which is designed to provide service users and their representatives with information about the home, to enable them to decide if the home is able to meet their needs. This document provided information about the qualifications and experience of the provider, manager and staff. It also described the philosophy of care for the home and included details of the fees charged for residing in the home. Also included was information about the services and facilities provided including accommodation. The document was presented in both a written and pictorial format to make it more accessible to service users who might have comprehension difficulties. This document provided people with the necessary level of information required to enable them to make a decision about the homes ability to meet their needs. The one survey returned indicated that the person was asked if they wished to move into the home. The same service user also responded positively when asked if they had been provided with enough information to enable Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: them to decide whether or not to move in. The manager told us in the AQAA, We complete an in depth assessment prior to admission with full participation of the service user (if agreeable) in a place of their choice. The last admission to the home was in May 2009. Discussion with the service user indicated that they could not recall whether or not they had been involved in their assessment or not, however they could recollect having had an opportunity to visit the home and have a look around. Examination of the service users assessment showed that it contained information about their clinical diagnosis, education and social history. Care Homes for Adults (18-65 years) Page 13 of 30 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 living in the Tidings receive good quality care based on their assessed and identified needs. Evidence: The manager told us in the AQAA, We fully involve service users in the compiling and reviewing of their care/support plans. Each care plan examined started with a profile containing relevant information such as detail of next of kin, date of birth, and details of people involved in the persons care. For each person there was a range of individual care plans in place covering personal care, Education, Social Skills, Domestic Skills and Community Skills. Each of the care plans seen identified the need or problem and stated the objective that staff were trying to support the person to achieve. Guidance to staff was clear and concise. Staff spoken with during the course of the inspection said that they felt the care plans provided them with all of the necessary information that they required to meet peoples needs. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Service users spoken with spoke of being aware of their care plan and of having been involved in their development, they also confirmed they were involved in the reviewing of their care plan. Review documents examined showed that where necessary they were provided in an alternative format e.g. pictorially. The home operates a key worker system and discussion with service users indicated that they were aware of who their key workers were. Each person had a comprehensive range of risk assessments in place that described the identified risk and the responses required to reduce the risk. These assessments were also presented in a pictorial format to enable service users to be actively involved in their development. Care Homes for Adults (18-65 years) Page 15 of 30 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 living in the Tidings can expect to enjoy a lifestyle that meets with their wishes and needs. Evidence: The manager told us in the AQAA, We seek, offer and support service users with educational opportunities that specifically meet their needs and choices with transitional visits to allow informed choice. Only one of the two service users residing in the home attends college where they take part in a programme of learning which is designed to help prepare them for taking on work in the future. Both service users had activity planners which they had copies of posted in their rooms. Sampling of these plans indicated that service users were being actively involved in activities both within the home and in the wider community, these activities included: personal shopping, going to the cinema, gardening, sewing and needlework, making cakes, food shopping and going to feed the ducks. Both of the Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: plans seen had been signed by the service users, and during discussion they confirmed that they did partake in these activities on a regular basis. A survey returned indicated that service users were able to choose how to spend their leisure time. Discussion with the registered manager indicated that the home has an open door policy on the receiving of visitors. Service users spoken with indicated that they were supported to maintain links with their families. They are supported to do so by their key workers, who support them through the sending of letters and cards. Care records sampled showed evidence of details being kept of people who were important to the service users, these records also included details of important dates e.g. birthdays. The manager told us in the AQAA, We offer flexible meal times with service users having full participation with menu planning. Service users identify individually what they wish to eat. To enable this choice one service user uses pictures of reference as an aid to enable them to make a choice. Discussion with service users indicated that they are supported to take an active part in food shopping and both were supported to prepare meals either independently or with support if required. On the day of our inspection visit the service users had a light snack for lunch, as the main meal was to be taken in the evening, which service users said was to allow for normal daytime activities. Service users spoken with said that the meals provided in the home were good. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service can expect their personal and health care needs to be identified and provided for with the necessary support to ensure these needs are met as they would wish them to be. Evidence: The manager told us in the AQAA, We provide service users with same gender support, and their is a key worker system in place to support individuals. Sampling of records indicated that service users were supported by an all female support team, and the service did operate a key worker system. Discussion with service users indicated that they were aware of who their key workers were. One survey returned said that staff were good at listening. The manager told us in the AQAA, We provide care plans that record specific personal and health care support needed, which includes a separate file section for recording professional imput. Care plans contained a good level of detail about peoples health care needs, and how they needed to be supported to ensure that these needs were met. Records kept Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: included weight records, health monitoring form and seizure monitoring form. Evidence was seen of involvement from G.Ps dentists and opticians. The manager and staff spoken with were all able to demonstrate a good awareness of each individuals needs around health and well being. At the time of our visit neither of the service users had been assessed as being able to administer their own medication. Therefore medication was administered to them by the care staff. The manager told us in the AQAA, All staff have received medication administration training and our observations on the day of the inspection were that staff followed appropriate practices when administering and recording medication. Care Homes for Adults (18-65 years) Page 19 of 30 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 . People living in the home can be assured that any concerns or complaints they may have about the home will be listened to and acted upon. Evidence: The manager told us in the AQAA, We have developed a user friendly complaints procedure, and all staff have received training around safeguarding. There is a complaints procedure available in the home, which was posted on the wall in the hallway of the home. The procedure was presented in both a written and pictorial format to enable access to service users with comprehension difficulties. Service users spoken with were aware of the procedure and said that they knew who they should speak to if they were unhappy about something. Since the last inspection there have been no complaints received by us and there have been none recorded by the service. The manager told us in the AQAA, We have raised Safeguarding of Vulnerable Adult concerns in line with procedures when it has been felt that protection was needed regarding an individual within the home. Since our last key inspection one referral had been made in relation of an adult protection issue, this referral had been fully investigated, and ultimately was not upheld. The service had referred the matter in an appropriate and timely manner. The manager and staff were able to demonstrate a commitment to ensuring people are Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: safeguarded and were aware of their responsibilities. Training records examined showed that staff had received training in adult protection. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People can enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: The manager told us in the AQAA, We offer a clean, homely environment in the community that is close to local amenities, which promotes independence and ensures dignity and respect. As previously reported the home provides a comfortable and homely environment for the people who live there. At this inspection the home was bright and well maintained and the furnishings and fittings continue to be of a good quality. Peoples individual rooms were decorated to a good standard and evidence was seen of people having their personal possession around them e.g. photographs, ornaments and soft toys. Service users benefit from a small enclosed garden to the rear of the property which was accessible via patio doors form the lounge. Service users spoke of sitting out in the garden during the recent bout of good weather. There was a good standard of cleanliness throughout the home with no evidence of Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: any unpleasant odours. The home only accommodates two service users so the facility for dealing with peoples laundry was a domestic washing machine which was suitable for the level of usage that it received. Care Homes for Adults (18-65 years) Page 23 of 30 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 . People living in the home can be confident they are cared for by a competent staff team who can meet their needs and who have been employed following thorough recruitment checks to ensure people are safeguarded. Evidence: The manager told us in the AQAA, We ensure that service users are supported on a 2:1 ratio. Examination of records as well as discussion with a service user and the manager indicated that people are supported by one member of staff Monday to Friday throughout the day. At weekends an additional member of staff is put on shift during the day to facilitate activities. Nighttime support is provided by sleep-in staff. Discussion took place with staff about whether they felt the staffing levels were adequate to meet the needs of the service, they responded that they felt they were. They went onto say that the service users were able to be supported safely by one member of staff when accessing the community, which they and a service user spoken with said they did on a daily basis. Comments received from surveys returned indicated that staff listened to what service users wanted and responded accordingly. The manager told us in the AQAA, We have introduced new skills for care induction standard packs for all staff and all staff have individual training packs. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Personnel records examined contained evidence that staff have an induction using the skills for Care Common Induction Standards. through discussion the manager explained how they use the Skills for Care Knowledge sets to work with staff to develop their knowledge and skills. Staff training files that were sampled indicated that over the last year staff had been provided with training on fire prevention, safeguarding, food hygiene, first aid, moving and handling, mental capacity act and infection control. Staff spoken with said that they were provided with a good level of training which was relevant to the needs of the service users. The home employs two care staff, both of who hold a National Vocational Qualification (NVQ) at level two or better. The manager told us in the AQAA, We operate a robust recruitment practice, which includes involving service users in the staff recruitment process. At the time of our visit staffs personnel files were being stored in the organisation central office situated close by in Halstead, only one staff file was held in the home that being the file of the person most recently appointed. This file was examined and was found to be well organised and contained all of the documentation required by regulation including identification photographs, application forms, written references, Criminal records Bureau (CRB) enhanced disclosures and Povafirst checks. The registered manager was reminded that access to staff recruitment files is always required as part of any inspection, therefore provision must be made to ensure that these files are always either directly accessible or obtainable at anytime. The manager told us in the AQAA, We carry out regular supervisions with our staff. During the previous inspection we were told by staff that one to one supervision was provided every every six to eight weekly, records sampled during this inspection indicated that this was still the case. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is appropriately managed in the best interests of the people living there. Evidence: The registered manager holds a National Vocational Qualification (NVQ 4) in both management and care and continues to update her skills and knowledge with ongoing training. The manager demonstrates a good knowledge of the needs of people living in the home and works pro actively to improve the home in the best interests of the people living there. A member of staff spoken with said that the manager is always available either in person or via the phone if we have any concerns or issues and provides us with a clear sense of leadership and direction. Staff spoken with said that regular staff meetings and supervisions were held every 46 weekly, in addition bi-weekly key worker meetings are held between the key workers and the manager, where any care related concerns or issues were discussed. The manager told us in the AQAA, We send out quality assurance questionnaires to Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: parents and professionals. Discussion with the manager confirmed that they do send out questionnaires to help them review and keep under review the quality of the homes service provision, however at the time of our visit non from this year were available for us to inspect. Discussion with service users however as well as responses received from surveys indicated that service users were consulted with about all aspects of the running of the home. it was also observed by us during outr time in the home that service users were consulted with about issues going on in the home. A range of health and safety documents examined were all found to be in order and up to date, those examined included; gas safety certificate, electrical installation certificate, and records relating to Portable Appliances Testing (PATs). Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  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 28 of 30 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 Description 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 Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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