Care Home: Third Row, 11-12

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What the care home does well The most recent admission was very well planned. The needs of the person most recently admitted were very carefully assessed. Staff are trained and work well together. What has improved since the last inspection? There are more staff on duty. Staff meet with the manager more often. Staff have had some special training so that they can support service users better. What the care home could do better: Make sure that medications are better organised and this will avoid mistakes. Make sure staff get more out of one to one meetings with the manager. Key inspection report Care homes for adults (18-65 years) Name: Address: Third Row, 11-12 11-12 Third Row Linton Morpeth Northumberland NE61 5SB     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: Carole McKay     Date: 2 5 0 6 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 26 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 26 Information about the care home Name of care home: Address: Third Row, 11-12 11-12 Third Row Linton Morpeth Northumberland NE61 5SB 01670861417 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: coley@eldcare.fsnet.co.uk Mr John Thomas Cole,Mrs Delia Cole care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Linton is a small village situated in a rural ex coal mining area of Northumberland. The village is a small close-knit community comprising rows of attractive terrace houses. The village has a small shop, which is run by the local community as a co-operative, and a local pub. 11/12 Third Row, Linton is a four bedroom terraced house created from two converted houses. The house has a large private garden. Three men live at the house. Linda Algar manages the home, under the supervision of Mr Cole. A small team of experienced staff are employed. Information about the home and reports from previous inspections are available. 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 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: We visited the service on 25 June 2009 We talked to service user and the staff on duty. A specialist inspector looked at the medication. We told the manager what we found. Care Homes for Adults (18-65 years) Page 5 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 6 of 26 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 7 of 26 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. Accessible information is available to help people make choices about the home before they move in. Service users will have their needs fully assessed before they move to the service. Evidence: Each service user has copy of the service user guide. Since the last inspection the service has produced a version of the guide on DVD so that prospective service users can more easily get to know about the service. The provider of the service, Mr Cole, said that he intended to improve on the work already produced. Since the last inspection the home has admitted one person. The records show that this admission was very well planned and prepared. This included obtaining the Care Management Assessment and other supporting assessments from other specialists and interested parties. The staff said that entire staff team had attended preparatory meetings with staff from a local hospital to provide a smooth transition for the person moving into the home. Care Homes for Adults (18-65 years) Page 8 of 26 Evidence: Several introductory visits were planned for the person before finally moving in. These included day visits as well as overnight stays. Both the staff and the service user concerned said that this had worked very well. The records show that part of the assessment process included risk assessment and risk management planning. These are clearly recorded. Care Homes for Adults (18-65 years) Page 9 of 26 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. Service users will be consulted and supported to identify their needs and to safely manage any risks to their well being. Their individual needs will be met. Evidence: The service user plans for three service user were examined. These show that, since the last inspection, further progress has been made in expanding the information in the service user plans. In particular- there is more emphasis on the things that people can do for themselves and/or things they would like to do. This gives the plans more of a person centered approach. Where possible service user have been involved in reaching decisions and any restrictions ( to do with eliminating risk from harm for example) are clearly accounted for. Care Homes for Adults (18-65 years) Page 10 of 26 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. Service users are supported to enjoy a healthy and active lifestyle, in line with their choices and abilities. Evidence: None of the service user are employed. However two service users attend daytime activities. One service user voluntarily helps out at the local community shop. One person is beginning to develop a new life in the local community, trying different activities with the support of the staff. Some activities are offered in the home, for example a small art group meets at the home each week. Two of the service users are very involved in this group which is well established in supporting people with learning disability to develop their art work. Both people have produced a significant portfolio of work. Both are proud of this achievement. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Other hobbies are also developed around the interests of the service users. For example a small greenhouse is being used to develop one service users interests in growing vegetables. There is a safe regime at the home that is relaxed and informal. During the visit service users were supported to make choices and decisions about how they spent their time and to describe how they were planning ahead for holidays and shorter excursions. Each service user had an opportunity to go out during the visit. One person regularly visits a friend and has taken a holiday with them recently. The home does not have a designated cook. Care staff prepare the meals and service user are involved as they wish, or sometimes they may make a simple meal themselves, if they are safely able to do so. Mealtimes are flexible and menus show that meals are usually home cooked and freshly prepared. Care Homes for Adults (18-65 years) Page 12 of 26 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. Service users receive the personal support they require in accordance with their preferences. Health care needs are addressed. Medication arrangements do not completely guard against potential errors. Evidence: The service user plans show that service users are supported to access the local health services for routine health checks. This support includes regular visits to the well man clinic, as well as dentists and opticians. For more complex needs the service service users are supported to attend specialists outpatient clinics. Following a recent operation one person has been supported to become largely self caring in managing the post operative care. The staff also support a service user with catheter care, under the guidance of a community nurse and following training. Service user plans describe what level of support with personal care people prefer. The medication arrangements were inspected separately on the 14th July 2009 by a pharmacist inspector, Mr Mike Earnshaw. His findings are stated below; Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: Pharmacist inspection of 11/12 Third Row Findings Medication administration record (MAR)charts are printed in house and are no longer handwritten. There is no signature on the MAR to identify who prepared it nor is the document signed by a second person to confirm that all entries are accurate and complete. Some handwritten entries for medication recently prescribed were not signed and countersigned to confirm their accuracy. There were no gaps in the medication records and there were no discrepancies between the quantities of medicines remaining and the administration records for a sample of medication. This suggests that medication is being given as prescribed. Draft protocols for the use of homely medicines were looked. They do not contain sufficient information to inform carers on what dose of medication should be given , nor give any limit on how long homely medicines may be administered before discussing the matter with the service users doctor. A comprehensive record of medication received, administered, sent out with a service user going on a visit, or returned to the pharmacy for disposal is maintained. No medication audits are carried out. Medicines are stored in a locked cupboard but some fridge medication is stored in a plastic carton in the unlocked domestic refrigerator. No risk assessment has been undertaken to support this practice. Dates of opening of medication with a short life once opened is not always recorded on the container. The medicines policy is brief and requires updating. It does not give sufficient guidance for staff on record keeping, handwritten entries on MAR charts and the management of medicines with a short use once opened. Staff do not have access to a British National Formulary which provides useful information relating to medicines in use in the service. Care Homes for Adults (18-65 years) Page 14 of 26 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. Service users know they can raise concerns.The procedures and staff training protect service users from harm. Evidence: The home has a complaints procedure and a complaints record. The homes procedure includes the contact details. No complaints about the service have been received since the last inspection. Service users said that they knew who to speak to if they were unhappy with the service and were aware of the homes complaints procedures. The Service User Guide contains a copy of the Complaints Procedure. One service user said that if he had complaints he would talk to the staff, the manager or the owner. The home has staff guidance and procedures in place to protect vulnerable adults from abuse, including whistle blowing procedures. A copy of the local Northumberland Safeguarding Practice Guidelines was also available. Though this was dated 2003 and will have been updated. The manager said that all of the staff had received awareness training in this subject. The staff on duty confirmed this and said they would not hesitate to report any bad practice. Some staff are to undertake further training to do with mental capacity and deprivation of liberty in the near future. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: The system for dealing with service users finances was examined. The Home maintains financial records on behalf of the residents; each has an individual bank account. There was evidence of personal spending and receipts are kept. Care Homes for Adults (18-65 years) Page 16 of 26 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 home provides a clean, spacious and comfortable living space for service users. Evidence: The home is in good order throughout. The people living at the home have a choice of using two large living rooms, a conservatory and a large kitchen/ diner on the ground floor. Toilet and washing facilities are located on both floors. This provides for spacious accommodation for three persons. Each service users has their own bedroom and these have been decorated to individual wishes. One person confirmed this during the inspection. The kitchen is clean and pleasant and improvements have been made to this area since the last inspection. Toilets and bathrooms are clean, tidy and suited to the needs of service users. These too have been upgraded since the last inspection. The home has a small laundry in an area off from the kitchen. This is domestic in style. Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: The staff confirmed that they have been provided with information on infection control. All areas of the home were seen to be clean, hygienic and free from unpleasant odours. Care Homes for Adults (18-65 years) Page 18 of 26 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. Service users at the home are supported by a team of staff who are confident, have been well trained and generally well recruited. Evidence: Staffing arrangements are flexible to meet the needs of the service users. Recently improved staffing levels have been agreed with the local placing authority. These are; that there will be a minimum of two staff on duty through the day and two night staff, with an agreement that these arrangements will be reviewed in two years and six months respectively. The owner has other services based in Linton. Staff from these services cover for holidays and other special circumstances. Staff records are not kept at the home. This has been accepted under a previous arrangement with the Commission for Social Care Inspection and is reviewed at each inspection. The records were examined during the second date of the inspection at the owners office. They showed that appropriate checks are carried out prior to staff being employed, which protects the residents. Though one file did not contain two written references. This matter was raised in the report for another of the services in the group. Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: Training programmes are in place for staff to receive up to date health and safety training. The staff also confirmed that they receive specialist training to meet the individual needs of the residents. Six permanent staff are employed in the home. They have all completed training to do with learning disability. Six members of staff have completed National Vocational Qualification (NVQ) Level 3. A file of courses available to the staff team is maintained in another home owned by the proprietor. All of the staff have recently undertaken training in specialist care related to the needs of one of the service users. the staff said that they had found this very beneficial in supporting the person to adapt to the new environment. Since the last inspection formal supervisions have been taking place regularly. But most of the records of these were statements disclaiming the need for a one to one meeting. The staff on duty stated the manager and the owners are supportive and approachable. Good teamwork was evident during the visit. Good relationships were observed between the service users and the staff. One service users said he enjoyed very good relationships with the staff team. Care Homes for Adults (18-65 years) Page 20 of 26 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 managed in a way that promotes team work to ensure the best interests and safety of the service users. Evidence: The manager has experience in working with adults with learning disabilities and is currently undergoing training to achieve a National Vocational Qualification, Level 4 in care and management. There has been an interruption to this training of late but the manager has resumed this course of study recently. Meetings are held in the home on a regular basis. The minutes showed that service users are asked their opinion on the day-to-day running of the home. There is a Quality Assurance policy statement. The owner makes monthly visits and reports of these visits are available. He visits the service frequently and is in day-today contact with staff, service users and service users families and friends. Maintenance contracts and test certificates are in place and fire safety equipment is Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: tested at the appropriate intervals. This helps to ensure the safety of service users. The staff confirmed that they had received up to date health and safety training. No safety hazards or unsafe practices were observed during the inspection. Care Homes for Adults (18-65 years) Page 22 of 26 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 23 of 26 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 manager must acheive the registered managers award qualification. In order that her good practice can be underpinned and consolodated with further training. 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Service user plans should continue to be developed. And service users involvement in developing these should also be further promoted. The pharmacy should be requested to provide appropriate quantities of labelled medication where practical to meet the needs of service users who will be going on planned leave away from the home. Any handwritten medication entries on MAR charts should be signed, dated and countersigned by a second person to confirm their accuracy and to reduce the risk of error when copying information. A list of signatures and initials should be maintained for staff authorised to administer medicines. Page 24 of 26 2 20 3 20 4 20 Care Homes for Adults (18-65 years) 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 5 6 20 20 A current BNF should be obtained . Homely remedy protocols should contain full guidance on what doses of medication can be given and for how long before referral to a doctor. The medicines policy should be updated to provide more detailed guidance on managing medicines in the service. Regular audit of the medication system should be carried out including reconciliation of medicines stock against administration records. This will help identify any medication problems promptly and demonstrate that staff are following the medicines policy. The home should obtain a copy of the most recent version of the guidelines for safeguarding vulnerable adults from the Northumberland Safeguarding Team. As good practice and to support staff who are working with clients who have some special support needs, staff should be encouraged to attend regular one to one supervision meetings with their manager. This will provide staff with equal opportunity to discuss their feelings, views and opinions, aswell as their own support needs in confidence. 7 8 20 20 9 23 10 36 Care Homes for Adults (18-65 years) Page 25 of 26 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). 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