Care Home: Twynhams

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What the care home does well The home makes sure it gets information about people`s needs before they move in. This helps to ensure staff provide the right support for people.People are supported to take part in a range of activities they enjoy.There are good systems for dealing with complaints.The home is well maintained. It is clean, comfortable and safe for people.Staff are well trained. This helps to ensure staff can meet people`s needs. What has improved since the last inspection? People now have good care plans that contain clear information about how staff should meet their needs.People are now given better support to manage the risks they face. This helps to keep people safe.The home now has better systems to support people to take their medication. This helps to ensure people receive the medication their doctor has prescribed.Staff now make sure any allegations of abuse are reported. This helps to ensure action is taken to keep people safe.There are now good systems to check what improvements need to be made in the home and make sure they happen. What the care home could do better: We have not said the provider needs to take any action following this inspection. The manager has a plan of improvements she would like to make and should ensure they happen. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Twynhams Old Christchurch Road New Milton Hampshire BH25 6QB two star good service The quality rating for this care home is: 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: Craig Willis Date: 1 8 0 5 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 Audience Further copies from Copyright Inspection report CSCI 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Twynhams Old Christchurch Road New Milton Hampshire BH25 6QB 01425618950 01425618950 twynham@truecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Truecare Group Ltd Name of registered manager (if applicable) Mrs Marie Anne McLoughlin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 care home 7 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). The maximum number of service users to be accommodated is 7. Date of last inspection 2 1 0 5 2 0 0 8 A bit about the care home Twynhams is owned and managed by Truecare and is registered to provide personal care and accommodation for up to 7 people who have a learning disability. The home is located close to local amenities in New Milton. The house is a two storey detached property with car parking for several vehicles and a garden to the rear. People have a single bedroom and five of the rooms have en-suite facilities. The area director reported following the visit that the weekly fees for living at Twynhams range from 1124 to 1821 pounds 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 How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 18 May 2009. During the visit we spoke with one person who lives in the home, staff on duty, the manager and an area director for the provider. We received surveys from four people who live in the home and nine staff. We looked at the shared areas of the home and records kept in the home during the visit. What the care home does well The home makes sure it gets information about peoples needs before they move in. This helps to ensure staff provide the right support for people. People are supported to take part in a range of activities they enjoy. There are good systems for dealing with complaints. The home is well maintained. It is clean, comfortable and safe for people. Staff are well trained. This helps to ensure staff can meet peoples needs. What has got better from the last inspection People now have good care plans that contain clear information about how staff should meet their needs. People are now given better support to manage the risks they face. This helps to keep people safe. The home now has better systems to support people to take their medication. This helps to ensure people receive the medication their doctor has prescribed. Staff now make sure any allegations of abuse are reported. This helps to ensure action is taken to keep people safe. There are now good systems to check what improvements need to be made in the home and make sure they happen. 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 If you want to speak to the inspector please contact Craig Willis The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622 724950 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 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 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 . There are good systems to assess peoples needs before they move into the home. This reassures people that the home will be able to meet their needs. Evidence: The manager reported in the annual quality assurance assessment that one person has moved into the home since the last inspection. The manager also reported that the home has a comprehensive referrals and admissions process, which involves a full assessment of peoples needs, goals and aspirations before they are offered a place in the home. We inspected the records of the person who moved into the home since our last visit. These records contained a placement assessment report completed by the companys referrals manager. This assessment included details about the persons health, medication, communication, skills, behavioural and emotional issues, risk factors and mental capacity. The records also contained an assessment by the persons social worker and a clinical risk assessment completed by the health team. The documents seen contained evidence that the person was involved in the assessment process and their views were taken into account. Four people who live in the home completed a survey for us. All four said they were asked whether they wanted to move into the home and all said they received enough information about the home before they moved in so they could decide whether it was the right place for them. 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 . There are good care planning and risk assessment systems, which involve people in making decisions about their lives and helps staff to provide the support that people need. Evidence: Following the last inspection we made a requirement that care plans must include details about how peoples identified needs should be met. Following the inspection the provider sent us an improvement plan that said peoples care plans had been reviewed and updated to reflect all of their identified needs. The manager reported in the annual quality assurance assessment that each person has a personal care plan which reflects their changing needs and personal goals and is evaluated monthly. We inspected the care plans of two people who live in the home. Both of the plans contained detailed information about how the persons assessed needs should be met. The plans contained details about any restrictions agreed with the person and their care manager, for example access to their en-suite bathroom. One person whose plan was looked at had identified needs about managing their behaviour and aggression. This persons plan contained clear details about the methods of intervention staff should use, when it should be used and the training that staff must complete before providing this support. The care plans had all been signed by the person who lives in the home. Records were available of monthly meetings between people and their key worker. These meetings reviewed peoples objectives and agreed any changes that were necessary to the care plans. The requirement made following the last inspection about care plans had been complied with. Details of how people should be supported are set out in the care plans, including any communication needs that people have. Four people who live in the home completed a survey for us. One said they always make Evidence: decisions about what they do each day, two said they usually do and one said they sometimes do. Three people said they were able to do what they want to during the day, in the evening and at the weekend; one person answered no to all three of these questions. Following the last inspection we made a requirement that risk assessments must be reviewed following incidents to ensure they were still relevant. Following the inspection the provider sent us an improvement plan which said they had introduced a new system to regularly review and amend risk assessments. The manager reported in the annual quality assurance assessment that they operate a risk management framework which protects people from potential harm but allows people to take reasonable risks. We looked at the risk assessments for two people who live in the home during the visit. Both people had risk assessments in place covering the risks identified in their needs assessment. These assessments contained detailed information about the action staff should take to manage the identified risks and had been regularly reviewed, including a review following incidents. This requirement has been complied with. 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 . The home provides good support for people to take part in a range of activities, to maintain contact with family and friends and to have a healthy diet. Evidence: People are supported to take part in a range of activities including day services, swimming, drama, arts and crafts, jigsaws, knitting, walks and going out to local pubs and cafes. Each person has an individual programme of activities, which is based on their needs and wishes. People are supported to take part in household jobs, for example cleaning and meal preparation. Details of the support people need with these tasks is included in their care plans. People are supported to maintain contact with family and friends, with staff providing support for people to visit family where necessary. Four people who live in the home completed a survey for us and all said staff always treat them well. During the visit staff were observed interacting with people in a friendly and respectful manner and respecting their space, for example asking permission to enter bedrooms. The home has a planned menu that provides two choices for lunch and dinner. The menu is developed with people who live in the home as part of their regular meetings and is displayed in the kitchen in picture format to make it more accessible. One person who lives in the home was spoken with during the visit and reported that the food was good and staff treated them well. 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 . Peoples personal and health care is well met by staff who know their needs and there are good systems to safely store and administer peoples medication. Evidence: Care plans contain details of the personal care support people need and how it should be provided. Four people who live in the home completed a survey for us; all four said staff always treat them well, three said staff always listen to them and act on what they say and one said staff usually do this. Staff spoken with during the visit demonstrated a good understanding of peoples needs and how they should meet them. People are supported to attend a range of health services, including GP, nurse, dentist, psychiatrist, speech and language therapist and optician. Details of consultations are recorded and include any advice given by the practitioner. Following the last inspection we made requirements that medication must be accurately recorded, including any directions from doctors and there must be specific guidance when people are prescribed as required medication. Following the inspection the provider sent us an improvement plan that said the medication systems had been changed to meet the requirements. Peoples medication is kept in a locked cupboard in the office, with a suitable cabinet to store controlled drugs if necessary. Since the last inspection guidelines have been developed for people who are prescribed medication to be taken as required and are kept in both the medication records and peoples personal records. These guidelines set out what the medication is for and at what point people should be supported to take it. The medication records also contained a letter from one persons prescribing doctor about a change in the doseage of their medication. The requirements about medication from the last inspection have been complied with. The medication administration record for the current month was inspected and had been fully completed. This gave a record of medication coming into Evidence: the home and when people were supported to take it. A record was also available of medication that had been returned to the pharmacist. There has been one incident in which staff adminstered the wrong medication. This incident was fully recorded and appropriate steps were taken, for example immediate consultation with the GP for advice and the staff members involved were stopped from administering medication until the investigations were completed. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are good systems for dealing with complaints and responding to allegations of abuse. This gives people confidence that any complaints will be taken seriously and responded to. Evidence: The manager reported in the annual quality assurance assessment that the home has a complaints procedure that has been provided in a pictorial format to aid understanding. During the visited the procedure was displayed on a notice board and was available in peoples personal records. All four people who live in the home that completed a survey for us said they know who to speak to if they are not happy and how to make a complaint. The home has not received any complaints since the last inspection. We have not received any complaints about the home since the last inspection. Staff have completed training in keeping people safe from abuse. Staff spoken with demonstrated a good understanding of the action they should take if abuse is witnessed, reported or suspected. There is a policy and procedure on safeguarding adults and the prevention of abuse. Following the last inspection we made a requirement that allegations of abuse must be reported under the adult protection procedures to ensure action is taken to safeguard people affected. Since the last inspection the home has reported five incidents to adult services under the safeguarding procedures. Two of these incidents involved aggression between people who live in the home and adult services were happy with the procedures in place to keep people safe. Two of the incidents involved allegations of verbal abuse from staff to people who live in the home. On both occasions adult services asked the home to conduct their own investigations into the allegations and deal with them through their disciplinary procedures if necessary. The final incident concerns a person being supported to take the wrong medication. Again, adult services asked the home to conduct their own investigation and report back to them with the findings. Records were available for all of the incidents and were inspected during the visit. The requirement made at the last inspection regarding reporting incidents under the safeguarding procedures has been complied with. Evidence: The financial records of two people were inspected during the visit. There was clear information about the money held in the home, with records of expenditure, receipts and regular checks of money held. The money is individually stored in a safe and the balance recorded matched the cash held for both people. 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 is well maintained and provides a clean, comfortable and safe environment for people. Evidence: All of the homes communal areas were viewed during the visit. The home is well maintained, with good quality domestic furniture and fittings. People living in the home have their own bedroom and share the use of a lounge, conservatory, dining room, kitchen and shower room. There is a shed in the garden that is used as an activities / art room. There is a planned maintenance and renewal programme. A new company has recently taken over a contract to provide maintenance in the home which the manager reported was working well after some initial teething problems. The home has infection control procedures and staff have received training in them. All four people who live in the home that completed a survey for us said the home was always clean and fresh. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff are well trained and there are good systems to check staff before they work in the home. This helps to keep people safe and ensure staff can meet their needs. Evidence: The manager reported that seven of the fourteen permanent staff have achieved the National Vocational Qualification (NVQ) at level 2 or above and all new staff will be encouraged to complete the award. Staff members were observed spending time listening to people and responding to requests for support. Staff spoken with said they felt there were enough staff on each shift to provide the support that people need. The manager reported in the annual quality assurance assessment that all staff who have worked in the home over the last year have had satisfactory pre-employment checks. We inspectd the files of three staff members who started working in the home since our last visit. The files had two written references, confirmation that a criminal records bureau (CRB) disclosure had been obtained and that the person was not on the protection of vulnerable adults list as unsuitable to work in a care home. The home has an on-going training programme and staff reported they received good training, which helps them meet peoples needs. Staff training records indicated people had completed an induction and courses including first aid, food safety, health and safety, epilepsy, moving and handling, infection control, strategies for crisis intervention and prevention, safeguarding and medication administration. Nine staff who work in the home completed a survey for us. Eight said they were given training that is relevant to their role, helps them understand and meet peoples individual needs, keeps them up to date with new ways of working and gives them gives them enough knowledge about health care and medication. 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 well managed and there are good systems to identify improvements needed and ensure they happen. Evidence: A new manager has been employed since the last inspection and has successfully applied to be registered with us. The manager had been registered as a manager of a different service for approximately five years and has completed the National Vocational Qualification in care and management at level 4. Staff spoken with were very positive about the manager and the support she provided to them. Following the last inspection we made a requirement that the quality assurance systems must be improved to ensure they were effective at identifying and planning improvements. The improvement plan from the provider said a new in-house quality assurance system was being developed. The area director for Truecare visits the home each month to assess the quality of the service being provided. Reports of these visits are made and include any required actions and an assessment of actions required from the previous report. The reports of these visits were viewed during the visit and included details about each person who lives in the home, any staffing issues, the views of the manager, a review of documents and records, an assessment of cleanliness and standard of maintenance, a review of any complaints and a review of the requirements from the most recent inspection report. In addition to these visits, staff complete a weekly quality assurance report that is sent to the area director. This report includes incident reports to ensure issues are reported and guidelines and care plans updated. An annual questionnaire is sent out to people using the service, family members, staff and care managers. The results of the questionnaires and other quality assurance systems are used to create an annual development plan. The requirement from the last inspection about the quality assurance systems has been complied with. Evidence: Records of the servicing and testing of the fire alarm, fire fighting equipment and gas boiler were inspected and were up to date. There were a number of workplace risk assessments in place, although they had not been reviewed since February 2008. The manager agreed to ensure these assessments were reviewed and amended if necessary. 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 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 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. ------=ext_Part_xpression.docscienc - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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