Care Home: Turning Point House

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What the care home does well The service ensures that the admission process for prospective service users is robust with many day and overnight stays at the home before an individual has to make up his/her mind on whether to move in on a permanent basis. This process enables the service to undertake a comprehensive assessment of needs, and also helps the new service user meet other people including staff and service users. Care plans are comprehensive and person centred with the necessary risk assessments in place. All documentation is regularly reviewed together with the service user and health and social care professionals. The service recognises the importance of person centred care and the need to develop and improve life skills, especially those around medication administration and the need to maintain a good mental health state. The service works well with health and social care professionals for the benefit of the service users. What has improved since the last inspection? The home`s safeguarding policy and procedures have been improved and staff have undertaken training in safeguarding vulnerable adults as required at the last key inspection in March 2009. Recruitment procedures have been improved and now comply with legislation. This process is now robust to ensure the safety of vulnerable people. What the care home could do better: The storage of controlled drugs, whilst safe, is not currently in line with the new legislation which was introduced in 2008. The relocation of this storage cupboard has been made a requirement in this report. Key inspection report Care homes for adults (18-65 years) Name: Address: Turning Point House 95 Blake Avenue Barking Essex IG11 9SB     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: Sandra Parnell-Hopkinson     Date: 2 3 1 1 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 25 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 25 Information about the care home Name of care home: Address: Turning Point House 95 Blake Avenue Barking Essex IG11 9SB 02082150840 02082150840 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Florence Ojuolape Bello care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding Learning Disability or Dementia - Code MD Date of last inspection Brief description of the care home Turning point house is a privately run care home registered to accommodate three adults, with mental health problems who are subject to the care programme approach (CPA). Turning point house is an ordinary terraced property in keeping with neighbouring properties, and is situated in the London Borough of Barking and Dagenham. There are three single bedrooms with shared toilet and bathroom facilities. There is also a lounge and kitchen leading to a small garden outside. It is situated within easy access to the town centre and local shops. Community facilities are available in the town centre. The home is staffed on a 24-hour basis, and is not registered to provide nursing care. Physical health needs are met by the local GP, with Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 2 4 0 3 2 0 0 9 Brief description of the care home input by specialist professionals such as the local Community Mental Health team (CMHT) and CPN service. The registered person provides a Statement of Purpose that sets out the objectives and philosophy of the service. A Service Users Guide is also available which provides information about the home and the service they expect to deliver. All service users are given a copy of the guide. The fees charged are available upon request from the manager. Care Homes for Adults (18-65 years) Page 5 of 25 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 arrived at the home to undertake a further key inspection as this was rated as an adequate (1 star) service at the inspection undertaken in March 2009. We looked at the requirements made at the previous key inspection and at the homes compliance with these. We also looked at the case file of a new service user, the training records, complaints procedure and safeguarding training, policies and procedures. Recruitment records were also viewed to ensure compliance with legislation. We were able to speak to a service user and staff. Care Homes for Adults (18-65 years) Page 6 of 25 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 7 of 25 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 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: In discussions with the proprietor/manager it was evident that she understands the importance of having sufficient information available to prospective service users to help them make an informed decision in choosing a home that will meet their needs. The home provides a statement of purpose and it clearly sets out the objectives and philosophy of the service supported by a service users guide. Admissions are not made to the home until a full needs assessment has been undertaken by a skilled and experienced member of staff. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the initial care plan. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective residents. Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: Prospective residents are given the opportunity to spend time in the home prior to making a decision to move in on a permanent basis. This period can extend over several weeks with day and overnight stays for the prospective service user. Service users are provided with a statement of terms and conditions and this sets out what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Care Homes for Adults (18-65 years) Page 10 of 25 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 are involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: In discussions with the proprietor/manager it was evident that the key principle of this service is that people living at the home are supported to be in control of their lives and that the service is fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as is possible. This was supported in documentation and case tracking including a brief discussion with a service user and observation. Care plans are person centred and are agreed with the individual, and include reference to equality and diversity. The plan is compiled with the service user and includes a range of information that is important to the individual. This includes risk assessments, their goals and aspirations, their skills and abilities and support needed by the individual to lead a purposeful and fulfilling life. As the service cares for people with mental health issues the care plan includes good information about health needs. Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: Comprehensive risk assessments are included and these are reviewed on a regular basis. The service sees the management of risk in a positive way in addressing safety issues while aiming for improved outcomes for the individuals. Where there are limitations, the decisions have been made with the agreement of the person, or their representative, and are accurately recorded. There are procedures to ensure that service users are informed of their rights to confidentiality. Service users are involved in the daily running of the service and weekly meetings are held with them to ensure that they are continuously involved in the development and review of the service. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their life style, and are supported to develop their life skills. They are encouraged and supported to take part in social, educational, cultural and recreational activities. Evidence: The service has a strong commitment to enabling service users to develop or maintain their skills, including social, emotional, communication and independent living skills. Individuals are supported to identify their goals and are supported to achieve them. This is particularly important for people who have enduring mental health problems. People who use the service have the opportunity to develop and maintain important personal and family relationships as was evidenced during the inspection process. Service users are involved in meaningful daytime activities of their own choice and Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: according to their individual interests, diverse needs and capabilities. Activities include membership of a local gym, a local college attendance, helping out at a local car repair facility and clubs such as Stepping Stones. Service users are also involved in the cleaning of their own bedroom and the communal areas of the home, cooking and laundry. Support is given around managing budgets and other financial issues and shopping. People are encouraged to access and enjoy the opportunities available in the local community such as using public transport, leisure facilities, restaurants and the service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours. The service also recognises the need to promote health eating, and ensure that meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Care Homes for Adults (18-65 years) Page 14 of 25 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 that people receive is based on their individual needs and the principles of respect, dignity and privacy are put into practice. Evidence: In discussions with staff it was evident that they had expert knowledge about the individual personal and health care needs of the service users, and this was confirmed when viewing the care plan of 1 individual. Service users receive effective personal support where necessary, and healthcare support is also effective using a person centred approach based on dignity, fairness, autonomy and respect. Staff were highly aware that the way in which support is given is a key issue for people with enduring mental health problems, and the care plan viewed clearly recorded the individuals personal and healthcare needs and how these were to be delivered, with the involvement and agreement of the service user. All support is flexible, consistent and is able to meet the changing needs of the service users. It was evident that staff respected peoples preferences and staff were observed to respond appropriately and sensitively to an individuals needs. Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: Service users are encouraged to manage their own healthcare but support is given, where necessary, to attend hospital and other health associated visits. The home has developed good relationships with the local community mental health team, and this is for the benefit of service users. Service users are registered with a local GP, and visit the dentist, chiropodist and optician as necessary. When necessary, the service arranges for health professionals to visit a service user at the home. The service has developed efficient medication policy, procedure and practice guidance. The service strongly promotes independence especially in the area of medication. Service users are encouraged and supported to manage their own medication, and programmes are in place to suit the individual needs so that ultimately people are able to take responsibility for administering their own medication which is essential for people with ensuring mental health problems. Staff spoken to recognised the implications of an individuals refusal to take medication, and risk assessments and strategies were in place. Staff involved in the administration of medication have been trained and the homes records on the administration, safekeeping and disposal of medication is compliant. However, due to a change in legislation the location of the controlled drugs cupboard must be addressed, and information on this can be obtained from the Commissions website, or from the homes pharmacist. This was discussed with the proprietor/manager during the inspection. Care Homes for Adults (18-65 years) Page 16 of 25 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 are able to express their concerns and have access to a robust, effective complaints procedure and are protected from abuse. Evidence: The service has an open culture that allows service users to express their views and concerns in a safe and understanding environment. The complaints procedure is supplied to people living at the home and service users know how to complain. A copy of the complaints procedure is displayed within the service. As required at the last key inspection, the service has reviewed the policies and procedures for safeguarding adults and staff have undertaken training in this area. Staff were aware of when incidents required external input and who to refer the incident to. The service has a whistleblowing policy and there is a clear system for staff to report concerns about colleagues. We were satisfied that staff would be supported if they reported any bad practice. At the time of this inspection there were no safeguarding issues. Due to the nature of the service staff understood what restraint was and that alternatives to its use in any form would always be looked for. Service users are involved in the decision making process about any limitations to their choice in this area, and assessments are always completed which involve the individual, where possible, their CPN or other professional within the care management approach. Care Homes for Adults (18-65 years) Page 17 of 25 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 physical design and layout of the home enables service users to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: The home provides a physical environment that is appropriate to the needs of the people who live there. The home is situated in a residential area of the London Borough of Barking and Dagenham and is near to community facilities such as shops and public transport. This is limited off-street parking to the front of the home. The bedrooms are single and furnished in accordance with the wishes of the individual occupants. The lounge/dining room was clean and well furnished and the kitchen was also clean and had the necessary white goods. The home was well lit, clean and tidy and is a no-smoking home. Where a service user wishes to smoke this would need to be outside in the garden area. Care Homes for Adults (18-65 years) Page 18 of 25 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 in the home are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: Staff have undertaken training in safeguarding vulnerable people and were clear about the steps that would need to be taken in the event of any safeguarding issue. There have not been any safeguarding issues at this service. Other training has included health and safety, mental health, food hygiene and the Mental Capacity Act. Some staff also have achieved a qualification at NVQ level 2, or 3 or 4. The proprietor/manager is very aware of the benefits of having a skilled, trained workforce and in discussions with staff it was evident that they were very aware of the individual needs of the service users. Staffing levels were appropriate on the day of the inspection, and levels are flexible to meet the needs of the service users. The service is very focused on delivering improved outcomes for service users and recognises the importance of staff being trained to meet the needs of people in a person centred way. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Since the last inspection in March 2009, the recruitment procedures have improved and are now robust with the necessary references, criminal records bureau disclosures and other employment checks being undertaken. Staff meetings take place and staff also have regular supervision on a 1:1 basis or through observation of practice. Care Homes for Adults (18-65 years) Page 20 of 25 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 management and administration of the home is based on openness and respect and is managed by a person who is qualified and competent to do so. Evidence: As required in the last key inspection report, the proprietor/manager has improved the recruitment procedures and reviewed the safeguarding policy and procedures and staff training in this area and that of mental health. The proprietor/manager is qualified and experienced and competent to run this service, and has spent many years as a health professional in the field of mental health. She has a clear understanding of the key principles and focus of the service and works continuously to improve the service. She is aware of the areas that still require improvement and this includes the reviewing of policies and procedures as the service develops. She is very aware of the need to ensure that comprehensive risk assessments are in place and that these are regularly reviewed and amended as necessary. Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: The service has a strong focus on person centred care with service users being very involved in the development of the service. The proprietor/manager and her staff have a strong ethos of being open and transparent and has developed good working relations with health and social care professionals. In discussions with the proprietor/manager she was able to evidence her knowledge of the new regulation regime which will come into effect during 2010, and also of the implications of the Mental Capacity Act for the service users at this home. As part of the development of life skills for service users, they are supported to manage their own money where possible, and currently this is the case with the service users accommodated. We did not look at maintenance records nor quality assurance at this inspection as these were reviewed at the key inspection undertaken in March 2009, and no requirements were made. Care Homes for Adults (18-65 years) Page 22 of 25 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 25 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 20 12 The registered person must ensure that controlled drugs are stored in accordance with the new legislation under the Misuse of Drugs Act. The controlled drugs cupboard must be located to an external wall, not within another cupboard, in accordance with the change in legislation. This information can be obtained from the homes pharmacist or from the information on the Commissions websit as discussed during the inspection. 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 Care Homes for Adults (18-65 years) Page 24 of 25 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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