Care Home: Ulcomb House

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What the care home does well Ulcomb House provides accommodation for up to 5 people with learning disabilities close to the town centre of Sittingbourne. The focus of the home is to support people towards a more independent lifestyle. There are very good assessment processes in place ensuring that all prospective service user`s needs can be met by the home with a transition process that is tailored to individual needs. Support plans are well developed and include training targets to enable service users to work towards their identified goals and promote their independence in a measured way. the plans are based on a person-centred model of care and support. People who use the service are actively involved in the day to day running of the home and have activity programmes based on individual needs and preferences. There are daily opportunities for people to engage in meaningful and structured activities as well as following chosen recreational pastimes. Staff demonstrate a good awareness of issues surrounding abuse and this is supported by a positive training package. The environment is clean, bright and well furnished. Service users commented on the quality and comfort of the environment. There are numerous opportunities for staff to develop professionally and a training and development package that supports this. Staff stated that they feel supported in the roles and that the home is a positive place to work. The organisation has developed robust quality monitoring processes involving the service users at the centre of this. Recruitment processes are well managed and all records pertaining to health, safety and welfare were up to date. What has improved since the last inspection? The home has continued to develop since the last inspection process. The service user guide and statement of purpose have been updated and have been developed in formats to aid understanding including an audio version. Staff have continued to work with service users to develop increased opportunities in relation to activities and promoting independent living skills. The role of deputy manager has recently been introduced to support the manager in her role and this process has been positively managed. What the care home could do better: No requirements or recommendations under the Care Home Regulations 2000 have been made as a result of this inspection. The home and organisation continue to develop the service proactively using effective quality monitoring processes. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ulcomb House 24 London Road Sittingbourne Kent ME10 1NA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joseph Harris     Date: 2 5 0 6 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 28 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Ulcomb House 24 London Road Sittingbourne Kent ME10 1NA 01795412230 01795410877 care@cartrefhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Robert William Tyler,Mrs Brenda Joyce Tyler care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users to be accommodated is 5 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability (LD) Date of last inspection Brief description of the care home Ulcomb House is a semi-detached property with accommodation on three floors, bedrooms being on the first and second floors. All rooms are single occupancy and have television points. The home offers accommodation and support for 5 young adults with learning disabilities, with the emphasis on assisting them to move towards a more independent life style. Services are individually tailored to meet the needs of the service users, offering opportunities to develop their skills as is appropriate. The home is situated on the busy A2 leading into Sittingbourne, with shops and other local amenities within easy walking distance. It is on a bus route and there is a main Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home line railway station approximately a quarter of a mile away. The current fees start from 1,295 pounds per week. Additional information regarding fees and facilities are included in the service users guide and are available from the registered provider. Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent 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: This key unannounced inspection process culminated with a site visit to the service on 25th June 2009. The visit commenced at 09:30hours and lasted for approximately 6 hours. Prior to the site visit a range of documentation was reviewed including the Annual Quality Assurance Assessment (AQAA) submitted by the home. The AQAA contains up to date information about the service including areas identified for improvement and changes over the past 12 months. The past inspection reports were also examined and any information received from or about the home. During the course of the visit a tour of the premises was conducted and discussions Care Homes for Adults (18-65 years) Page 6 of 28 held with service users, staff, the deputy manager and the Clinical Director. A range of documents and records were examined relating to service users, staff and the day-today running and management of the service. 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 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 Care Homes for Adults (18-65 years) Page 8 of 28 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users and their representatives can make an informed choice about the home and prospective residents needs are assessed. Evidence: The home has developed both a Statement of Purpose and Service Users Guide detailing the facilities and introductory aspects to the service. The service user guide is given to all prospective service users and is available both in a written format with pictures and symbols and in an audio version. There are plans to develop a video version in the future. Current residents have been involved in the development of the guide. The information in both documents is up to date and sufficiently detailed. There is a clear and comprehensive assessment process in place that includes the receipt of information from referrers and significant social and health care professionals. The home completes their own pre-admission assessment that covers all key areas of need, risk and preference. One pre-admission assessment was examined for a recently admitted individual, which provided evidence that this process is followed. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: The Clinical Director explained the transition process, which is flexible and based on individual requirements and needs. Following the initial referral the prospective service user is visited in their current accommodation by the Clinical Director at which point trial visits are offered. This process, it was reported, can last up to 8 months if need be and includes overnight stays and supported activities in and out of the home. Care Homes for Adults (18-65 years) Page 12 of 28 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. The individual needs and choices of service users are recognised and planned for. Evidence: Two individual service user plans were examined during the site visit. In both cases the plans had been developed in good detail providing a clear assessment of needs and guidance to enable staff to meet these needs. The preferences of individual service users are documented. The plans use a person-centred planning model and reflect the individuality of each service user. There is evidence of regular review and updating to reflect changing needs. Service users are involved in developing their own plans and work closely with the manager and key workers in this regard. Residents are encouraged and supported to take decisions affecting their day to day lives. This was evident through activity plans and records and through observation of staff and resident interactions. The home does not take a financial appointee role for any service users and this is managed independently of the service. There is a positive risk management programme that is designed to support and Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: promote safe, responsible risk taking. Guidance is developed to enable staff to minimise perceived risks and promote independence. The risk assessments are regularly reviewed and updated as required and cover a range of topics dependent on individual assessments. Care Homes for Adults (18-65 years) Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are actively involved in lifestyle choices and their independent living skills are promoted. Evidence: A wide range of activities have been explored to ensure that service users can choose what pastimes they wish to engage in. Each resident has an activity planner, which demonstrate a variety of activities both recreational and occupational are on offer. Service users, with staff support, were involved in a number of activities throughout the site visit including appointments, meals out and skills training. The staffing levels are such that service users can be sure that a member of the team is available to support them in their chosen activity. Staff work proactively with residents to support them in developing skills promoting independence. These activities are clearly recorded in support plans and service users work towards agreed targets and their Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: achievements are recorded and measured. A newsletter is developed on a regular basis, a copy of which was examined, that is developed by service users and staff. The organisation also has plans to develop a working farm in the local area providing work opportunities for service users. No visitors were present during the site visit, but the staff stated that friends and relatives are welcomed into the home at all reasonable times. The Clinical Director said that the involvement and participation of families is encouraged and the majority of residents have active relationships in this respect. Service users are consulted about menus and take an active role in the planning and preparation of meals from deciding menus to shopping and cooking. Service users are supported to make their own meals to promote independent living skills. The kitchen has two cooking areas to enable this process. The kitchen was well stocked with a good range of fresh foods. Care Homes for Adults (18-65 years) Page 16 of 28 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 personal and healthcare needs of service users are met. Evidence: Service users are supported by staff to attend to their own personal care needs as far as possible. The majority of residents are self-caring requiring minimal support with their personal care issues. However, any assistance required is clearly documented within the support plans and personal preferences are recorded and respected. The healthcare needs of the service users are clearly recorded and the outcomes of any consultations followed through. It was reported that service users receive good support from local Community Learning Disability Teams and all service users are registered with local GPs. residents receive an annual health care check and all other healthcare needs are addressed. Complimentary healthcare needs are met with regular input from chiropodists and dentists, etc. The home has developed clear medication processes. All staff have received necessary medication training. A weekly of audit of medication issues is conducted. All medication records were well maintained and up to date and the storage facilities appropriate for the needs of the home. Medication is kept in an organised and orderly Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: manner. Policies and procedures are in place covering all aspects of the medication process. The home supports service users to become self-medicating within a risk managed framework. Care Homes for Adults (18-65 years) Page 18 of 28 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 views are listened to and acted upon and they are protected from abuse. Evidence: The home has developed a clear complaints process that is displayed within the service and understood by service users. A copy of the complaints process is provided to all new and prospective service users. The Clinical director stated that any concerns and complaints aim to be addressed on an informal basis in the first instance, but there is recourse to the formal process if required. There is a system for recording complaints showing the outcomes of any investigations. There have been no complaints received since the last inspection process. Policies and procedures relating to the protection of service users against forms of abuse have been developed. In discussion staff members demonstrated a very good awareness of these issues and were able to clearly state the actions that they should take if they suspected any form of abuse. The manager of the home is a trained trainer in adult protection and all staff have received the recommended training on this topic. In addition staff also have received instruction addressing the Mental Capacity Act and the Deprivation of Liberty Safeguards. There have been no Safeguarding Vulnerable Adult alerts received in connection with the service since the last inspection process. Care Homes for Adults (18-65 years) Page 19 of 28 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 premises are suitable for the needs of the service user. Evidence: Ulcomb House is situated on a main road leading into Sittingbourne, there is parking available on the forecourt at the front of the building. The home is conveniently located close to the town centre with bus routes and a train station nearby. a tour of the premises was undertaken and some service users bedrooms were seen with their permission. There is a good range of communal space on the ground floor including a large lounge and a dining/activity area with an adjoining conservatory. The house is clean, bright and well maintained with good quality furniture throughout. There is a large garden to the rear of the building with separate offices. The garden is tended by some of the residents and there is a thriving vegetable patch managed by one of the service users. There are bathroom/shower and toilet facilities located conveniently throughout the building. All of the bedrooms are single occupancy and the rooms seen had been personalised according to taste. Residents are encouraged to take ownership of their rooms and are responsible for keeping them clean and tidy. Service users help with housekeeping tasks throughout the home. One service user said, I really like my room. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The kitchen and laundry facilities are suitable for the needs of the home. The kitchen has recently been fitted with a new cooker and it was reported that all equipment is in good working order. The kitchen has two cookers and work areas to enable service users to cook their own food with support if required. It was reported that the home meets all the requirements of the fire and environmental health departments. Care Homes for Adults (18-65 years) Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a well qualified and supported staff team. Recruitment processes ensure the welfare of service users. Evidence: The organisation has a positive outlook towards staff training and development. The Clinical director expressed his commitment to ensuring a well qualified and supported staff team. Over half of the current staff team have achieved at least a National Vocational Qualification at level 2 and staff are supported to gain higher qualifications in this respect. Discussions were held with a number of staff who demonstrated a very good awareness of the needs of the service users and of their roles and responsibilities in the home. It was evident that there is a commitment to putting service users first and a good knowledge base to enable this. All new staff work through an induction process including the Learning Disability Qualification which is externally assessed and an in-house induction programme providing a good foundation for working in the home and aspects of care and support. The organisation has developed a strong staff training and development programme incorporating both in-house and external training. All staff receive the required mandatory training and additional service specific courses covering a wide range of topics. An annual training needs assessment is completed identifying aspects of Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: training that are due for updating and other courses that support staff in their roles. The home also uses a range of competency assessments to underpin knowledge gained. Where possible the organisation aims to promote staff within the service providing a pathway to development. Two staff personnel files were examined that contained all the required information including CRB and POVA checks, two written references and proof of identity. The files are well organised and there is a dedicated member of the administration team who manages these. Service users are involved in the interview process and feedback gained to inform the recruitment process. Care Homes for Adults (18-65 years) Page 23 of 28 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 excellent 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 run, in the best interests of the service users. The health, safety and welfare of service users is promoted. Evidence: The manager was not present at the time of the site visit, but the inspection process was assisted by the Clinical Director and the Deputy Manager. The manager has been in post for a number of years and has attained all of the required qualifications to fulfill her role. Staff and service users stated that she has a positive management style and provides a good role model. Staff said that there is a very good team who all work well together in providing positive outcomes for service users. The home and organisation have developed robust quality monitoring processes. These include monthly monitoring visits conducted by a senior manager within the organisation, annual surveys of service users, staff and professionals. The results of these surveys are collated into an annual report. Service users are actively involved in the service development including participation in staff interviews, contributing to a periodic newsletter and involvement in the day to day running of the home. There was Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: evidence of staff and resident meetings taking place on a regular basis. All health and safety documentation examined was up to date. Service certificates were in place including gas safety, electrical wiring and portable appliance testing. fire safety and accident records were examined and up to date. Safe working practices are supported by policies and procedures and all staff have completed mandatory training. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 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 27 of 28 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. 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