Care Home: Upaya Ananda

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What the care home does well Upaya Ananda continues to provide a flexible service, based on the needs and preferences of those who use the service. Feedback from guests told us, that although they use the service for a few days at a time, the staff do their best to encourage them to enjoy and experience activities and a lifestyle that is often different and more diverse than they experience in their own homes. This was confirmed in discussion with a relative who told us, "the service is the best you could hope for. Our relative loves spending time at Upaya Ananda, people do like coming here, and the service has a good ethic in that respite is not just for parents, but for the guests as well". Feedback in five service users `Have Your Say` surveys told us, they were able to do what they want to do when they stay, including evenings and weekends and that staff treated them well and listen to what they say. One guest commented, "Upaya Ananda do everything well". Three staff `Have Your Say` surveys, told us what the service does well. Comments included, "Upaya Ananda provides a spacious and clean environment with lots of sources of entertainment and compatibility of guests is good" and "It is a happy fun and safe environment for guests to socialise in". The environment has modern facilities, with spacious rooms, which are pleasantly decorated and well maintained. When entering the home there is a friendly, happy and relaxed atmosphere. What has improved since the last inspection? `Fun` have worked with other agencies to provide `Share a Saurus` days, organising days out, so that guests` have access to places and activities of interest. A quality assurance and quality monitoring system has been developed to seek guests` and their relativies views. Each guest and their relative are asked to complete a questionaire after each visit to ascertain how the service is meeting their needs. Sampled questionnaires reflect guests and relatives are very happy with the service. Guests` bedrooms are nicely decorated, each with a different colour scheme and matching accessories. These have all recently been redecorated and new bedding provided. Where it was identified at the previous inspection that some guests` have presented behaviour that staff have found challenging, training has been included in the rolling programme to ensure staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. However, it was not clear that all staff have completed this training. What the care home could do better: Information about the service including the statement of purpose and complaints procedure will need to be changed to reflect the details of the new manager, the Care Quality Commission (CQC) and the new National Processing Contact (NPC) details. The service user guide and complaints procedures would be more meaningful and interesting to the people who use the service, if they were produced in a similar format to the brochure, using photographs and quotes from guests, giving their comments and experiences about the service. Development of care plans was discussed with the manager, they confirmed this is an area they are looking to improve, to develop individual care plans for each regular guest, which in turn will provide an assessment of how all aspects of the individuals daily routines, medical and health needs and emotional and behavioural support are to be met during the guests` stay. To protect people using the service under the age of 18, all staff employed to work with them must have a Protection of Children (POCA) check and the relavant child protection training. Additionally, to ensure the safety of guests and staff, inspection and testing of the fixed electrical installations in the home must be undertaken in accordance with the Electrical Engineers Wiring Regulations. The manager advised there are currently no guests` who look after their own money, all guest monies are locked in a cupboard in the staff office. However, should guests whish to retain responsibility for their own money, to protect the individual from the risk of financial abuse, they need to be provided with safe lockable storage, not the money tins currently provided in each room. Mania Ananda and Ananda are registered as Domiciliary Care Services (DCA), Upaya Ananda and the DCA are being run from a shared office. Fun operate a system, where certain aspects of these three services are being amalgamated. This includes staffing rotas, team meetings and policies and procedures. This however, can lead to a lack of transparency and difficulty differentiating between the services and whether resources are being allocated appropriately. Key inspection report Care homes for adults (18-65 years) Name: Address: Upaya Ananda 9 Station Road Hadleigh Suffolk IP7 5JF     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: Deborah Kerr     Date: 1 7 1 0 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 35 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 35 Information about the care home Name of care home: Address: Upaya Ananda 9 Station Road Hadleigh Suffolk IP7 5JF 01473823802 01473823802 nicky.fun@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Fun care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Upaya Ananda is a large modern detached house, with garden and grounds, situated near the centre of Hadleigh. Upaya Ananda are Sanskrit words meaning `Expedient means to joy, and the project is operated by a charity called FUN. The statement of purpose states that the home aims to provide short fun breaks to young adults with learning difficulties. Upaya Ananda provides a respite service only, and those using the service are referred to as guests in line with the philosophy identified in the statement of purpose. Upaya Ananda provides a service to young adults, and some children between the ages of 16-18. The ratio of service users under the age of eighteen is less than is required for registration as a Childrens Home; therefore the registration category of Care Home is sufficient. Three single bedrooms provide accommodation; one of the bedrooms and one of the bathrooms is wheelchair accessible. Wheelchair accessible transport is provided by the home. The service is not equipped to meet the needs of people with a history of Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 3 Brief description of the care home violence and does not porvide nursing care. The rates charged by the service have remained the same since they opened in 2004. There are two separate rates. Guests funded by Social Services are charged at a rate of £125 per night or £175 per 24-hour stay. Other guests are charged at a charitable rate of £25 per night or £35 for a 24-hour period. People receiving direct payments, the charges are £65 per night, £85 per 24 hour stay. This was the information provided at the time of the key inspection; people considering using this service may wish to obtain more up to date information from the home. These charges include a single room, evening and breakfast meal (packed lunch, where required) laundry and transport to leisure activitities. Care Homes for Adults (18-65 years) Page 5 of 35 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: This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The inspection was unannounced on a weekday, however there were no guests present on the day of the inspection, therefore arrangements were made to return on Saturday the 17th October to meet with three guests. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from five guests, two relatives and three staff Have Your Say surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Care Quality Commission (CQC) This document gives providers the opportunity to inform us, CQC about their service and how well they are performing. We also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A number of records were inspected, relating to guests using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking Care Homes for Adults (18-65 years) Page 6 of 35 with three guests, a relative and two members of staff. The manager and providers were available during this inspection and fully contributed to the inspection process. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Information about the service including the statement of purpose and complaints procedure will need to be changed to reflect the details of the new manager, the Care Quality Commission (CQC) and the new National Processing Contact (NPC) details. The service user guide and complaints procedures would be more meaningful and interesting to the people who use the service, if they were produced in a similar format to the brochure, using photographs and quotes from guests, giving their comments and experiences about the service. Care Homes for Adults (18-65 years) Page 8 of 35 Development of care plans was discussed with the manager, they confirmed this is an area they are looking to improve, to develop individual care plans for each regular guest, which in turn will provide an assessment of how all aspects of the individuals daily routines, medical and health needs and emotional and behavioural support are to be met during the guests stay. To protect people using the service under the age of 18, all staff employed to work with them must have a Protection of Children (POCA) check and the relavant child protection training. Additionally, to ensure the safety of guests and staff, inspection and testing of the fixed electrical installations in the home must be undertaken in accordance with the Electrical Engineers Wiring Regulations. The manager advised there are currently no guests who look after their own money, all guest monies are locked in a cupboard in the staff office. However, should guests whish to retain responsibility for their own money, to protect the individual from the risk of financial abuse, they need to be provided with safe lockable storage, not the money tins currently provided in each room. Mania Ananda and Ananda are registered as Domiciliary Care Services (DCA), Upaya Ananda and the DCA are being run from a shared office. Fun operate a system, where certain aspects of these three services are being amalgamated. This includes staffing rotas, team meetings and policies and procedures. This however, can lead to a lack of transparency and difficulty differentiating between the services and whether resources are being allocated appropriately. 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 9 of 35 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 35 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. Prospective people to use this service will have their needs assessed and they and their representatives will be provided with information, which clearly tells them about the service. Evidence: Copies of the homes statement of purpose and Welcome to Upaya Ananda brochure were provided at the inspection. These clearly tell prospective guests about the service, the fees and facilities. The brochure has quotes and photographs of guests, with comments about their experiences about using the respite service, such as, I come here to get away and have fun and I get to know loads of other people, guests and staff. The service user guide and complaints procedure would be more meaningful and interesting to the people who use this service, if they are produced in a similar format, as the brochure. An in depth assessment of the needs of individual guests is carried out with their families both at their home and in the course of visits to the service. Two guests care plans sampled confirmed each person had a comprehensive needs assessment, which Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: identified their preferences and needs in relation to a wide range of physical and emotional needs as well as daily routines, family support, resource issues and independence. These included, person centred information on which to base support, such as what makes me laugh, what can we do to prevent me getting angry, what things make me embarrassed, what I like to do evenings and weekends. The assessment includes information about activities and education the person is involved in during the week. Supporting Social Services Community Care Assessments and a psychologist report had also been obtained, providing detailed information about the individuals past and present needs. An independence criteria assessment is completed as part of the initial assessment, which covers all areas of the individuals daily living needs. These are scored 1 to 4, and the outcomes reflect the dependency levels of each guest and the staffing ratio required to meet their needs. The duty roster reflected staff are being rosterd according to guests needs. The home has a robust introduction procedure for people considering using the service, which includes the original referral date and assessment, a familiarisation visit, a home visit and the date of overnight stay including an evening meal. The dates of each (get to know the service) visit is recorded on an introduction form, held in each guests file. The form also has sections to record if the placement is agreed, reason placement was unsuccessful and general comments, however these sections had not been completed in the guests files looked at. This was discussed with the manager, that if used, as they have been designed for, these could provide useful information to staff about issues, which will ensure the guests needs, preferences and inspirations are met during their stay. Five service users Have Your Say surveys received, told us, they were asked if they wanted to use the respite service and that they had been provided with information about Upaya Ananda to help them make their decision. Comments included, the staff look after us very well and I am happy with everything the service provides. The AQAA states staff constantly check with quests what they would like to do, where they would like to go, and what they would like to eat. Every visit is intended to be fun for the guests, and so there is always ongoing consultation and choice offered. Guests and their relatives or guardians are asked to complete satisfaction surveys following each stay. The surveys ask if people had enjoyed their stay, felt safe during their stay, liked their room, the staff and the food. They also ask guests about places they would like to go to next time they visit. Responses seen in the surveys completed were very positive about the service, comments included, I like the company and spending time with other guests and staff and going on the internet and I like the food and going to Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: the pub and I like my supporter they were good, I want to come and stay again, I like just being around people and just having a good time. The manager and information provided in the AQAA confirmed the service is careful to ensure compatibility of people using the service and that every effort is made to have guests who get on well, with each other stay at the same time. This was confirmed in a guests file, which stated, I am happiest when I am staying with my friends XXX and XXX. This was confirmed in discussion with the guest and their friends who were staying at the service, for the weekend. There is no standard form of contract between the home and the guest, due to the nature of the business, providing short-term care. The service however, does have a block booking contract with Social Services for fourteen guests. Care Homes for Adults (18-65 years) Page 13 of 35 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. Individuals are involved in decisions about their daily lives and play an active role in planning the care and support they receive. Evidence: Guests files are divided into nine sections, which include the initial assessment, a current photograph of the person together with their personal details, including next of kin and other important contacts, care plans, risk assessments, medication and administration records, care notes and activity records, financial information, correspondence and historical information. One of the two files looked at also contained a pen picture providing a quick overview of important factors relating to the individual. Part of the pen picture, included a template for a my friends map and a family and friends contact details sheet, these had not been completed, although when we looked the information was available in the initial assessment. The AQAA states information gathered at the assessment stage is used to formulate comprehensive plans of care in order to encourage guests choice, rights, Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: independence and inclusion. However, the care planning process varies, most of the information about the guests is recorded in the initial assessment, although these are easy to read and do provide information about the individual, taking into account their needs and preferences they do not formulate a plan of how staff are to achieve meeting their individuals needs. The majority of guests are independent and only require support and prompting to manage their personal care needs, for guests with complex physical needs, a more in depth care plan had been completed, detailing the level of care and support they needed and the action required by staff. A fair access to care services assessment had been obtained for one individual, which provided information about their physical and sensory needs, mental health, behaviour and development, including information of how to support their communication difficulties linked to autism. These provided good details of how to manage their behaviour and personal care. Development of care plans was discussed with the manager, they confirmed this is an area they are looking to improve, to develop individual care plans for each regular guest, which in turn will provide an assessment of how all aspects of the individuals daily routines, medical and health needs and emotional and behavioural support are to be met during the guests stay. Individual and generic risk assessments have been completed, which include road safety, security of the premises, slips, trips and falls, hazardous substances and electrics objects, heating and hot water, furniture and food hygiene. Manual handling assessments are completed individually and reflect the capability of the guest. These reflect any equipment required, such as a hoist, the type of sling to use, and at which setting. The assessment process supports guests to live their life to the full, in the least restrictive manner possible, whilst reflecting actions to deal appropriately with events, to ensure their safety. Information provided in the AQAA and verified at the inspection confirmed the assessment process does take into account the each guests personal choices and autonomy. This was confirmed during the inspection, guests told us, they able to choose which room they stay in, choice of food, drink and entertainment. Five service users Have Your Say surveys received told us, they can make decisions about what they do each day , evenings and weekends. One person commented, the staff provide me with the opportunity to do things I want to do. Guests are encouraged to retain responsibility for their own money, they are provided with lockable money tins in their room. However, these are not secured and could be removed from the premises without the guests knowledge and therefore do not Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: protect the individual from the risk of financial abuse. The manager advised there are currently no guests who look after their own money, all guest monies are locked in a cupboard in the staff office. Guests are free to access their money with staff support. An audit of expenditure is recorded and provided to the family when they return home for inspection and analysis, with any remaining monies. Relatives are good at providing up to date information regarding health and welfare issues and changes in medication. Any changes are recorded on alteration forms. These are held at the front of the individuals file and provide staff with relevant and current information about the needs of the guest. Detailed care notes are kept covering the duration of each guests stay, these cover the activities they take part in, their choice of meals, what they did in the home and any health issues. The care notes reflect dates of further visits and suggestions made by the guest of what they would like to do. The care notes provide a good description of how people are supported and where they are provided with choice. Care Homes for Adults (18-65 years) Page 16 of 35 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. Guests who use this service are supported to make choices about their lifestyle and take part in social and recreational activities, which meet their expectations. Evidence: The services brochure states that Upaya Ananda offers people a break away service, which provides time to do something different, with different people, in a different place within this they aim to invite guests who are compatible and enjoy each others company. This was confirmed when talking with two guests who were deciding what they wanted to do during the day and in the evening. They spent time looking through the paper to see what was on at the cinema. This led to a discussion about films people had seen, which films and film stars they liked and disliked. They decided going to see the film, Fame. They also decided they wanted to go into town for lunch. They told us, we had a Chinese take away last night and watched a DVD. Communication between guests and the staff was good, each person had a say in making decisions. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: Upaya Ananda provides a respite service, and therefore, does not take on a lead role in identifying long term educational and employment resources for the guests. However, the home does provide transport for guests to access educational and employment establishments. Guests are also supported in having fun in their chosen leisure and social activities, attending clubs and associations and to maintain contact with families and other guests. The AQAA reflects where Fun have worked with other agencies to organise days out at guests request, called Share a Saurus days. This has helped to ensure guests have access to pubs, bowling, theatres, cinemas, restaurants, cafes, the seaside, swimming pools, shops, night clubs and church services. The AQAA reflects where guests are only with us for a few days, staff do their best in this timescale to encourage guests to enjoy and experience activities and a lifestyle that is often different and more diverse than they experience in their own homes. We encourage a holiday atmosphere. This was confirmed in discussion with a relative who told us, the service is the best you could hope for and we were recommended to use Upaya Ananda when our previous respite service closed, it is a good service, the staff are wonderful. Our relative uses the respite service two to three times a month, they do not need much care, just support, the staff do not need to look after them, they encourage and teach guests to do things for them self, helping them to learn new skills. Our relative does spend the occasional weekend and the staff encourage them to go shopping, out for meals and to help cook their own meals. The service is very good about whom they have together for respite and assessing if a guest is not appropriate. Our relative loves spending time at Upaya Ananda, people do like coming here, and the service has a good ethic in that respite is not just for parents, but for the guests as well. The kitchen and dining room are open plan and offer a family style environment. There are facilities for guests to make hot and cold drinks and preparing snack foods, as well taking part in the preparation and cooking of their evening meal. Fresh fruit and drinks are freely available. The fridge and cupboards contained a good range of fresh and pre packed quality foods, including well known brands. A weekly on line shopping service is used and staff make sure that they purchase foods in line with needs and preferences of the guests that will be staying. If a guest wants something different, they are encouraged to help shop for food. Housekeeping funds are available to purchase food of their choice. Information provided in the AQAA and verified at the inspection identified that as a result of listening to people who use the service an outdoor teak table and chairs and Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: a sun umbrella have been purchased so that guest can enjoy meals and tea on the decking, in the nicer weather. There are also plans to purchase an outdoor trampoline, upgrade the guest computer facilities and to improve access for the more physically impaired guests. Information obtained in two relatives Have Your Say surveys told us, Upaya Ananda provides a home from home environment and we are very pleased the service exists, our relative is always asking to go and stay there and the service is first class, it cares for and sees to all if the guests needs. CQC, Have Your Say surveys ask guests to tell us if they are able to make decisions about what they do each day, of the five surveys received three guests said they always made their own decisions where two people said they were sometimes able to make their own decisions. All five guests told us, they were able to do what they want to do each day, evening and at weekends and that staff treated them well and listen to what they say. One guest commented, Upaya Ananda do everything well. Care Homes for Adults (18-65 years) Page 19 of 35 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. Guests using this service can be assured that the principles of respect, dignity and privacy are put into practice and that the health and personal care they receive is based on their individual needs. Evidence: Information provided in the AQAA and verified at the inspection confirmed the home are able to support a variety of health care needs and that staff work closely with families and guests themselves to achieve the best health care standards during their short respite stay. Information about the guests general practitioner, dentist and other relevant health professionals were seen in their files. The guest files included their medical history, current health needs and appointments with healthcare professionals, where appropriate. The home has a wide range of aids and equipment to encourage maximum independence and comfort for guests using the service. These include grab rails, hoists, slings, and a shower bed. Where an individual is assessed as requiring equipment, for example to aid their mobility, risk assessments were seen, which detail the actions required by staff to aid safe moving and handling procedures. The Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: assessments confirmed that the staff receive in house training for moving and handling, including the use and regular maintenance checks of the equipment provided. Records seen confirmed the equipment is regularly serviced to ensure they are in good working order. The home has developed an efficient and comprehensive medication policy, procedures and practice guidance for ordering, prescribing, storing, administering and disposal of medicines. The administration of medicines was evidenced in the training records. Guests, who are able, are encouraged and supported to manage their own medication. This was confirmed in discussion with a guest who, showed us where there medication was in their room, they were able to tell us the name of their medication and when and how often they should take it. Medication administered to guests is kept in a locked cupboard in the kitchen and senior staff hold the key. Medication that requires refrigeration is stored in locked boxes and kept in the kitchen refrigerator. The practice of administering medication is generally safe and well managed. Medication charts are in place for each guest, which gives a description of why the drug is prescribed, the dosage and frequency. These also reflect any cautions/ side affects. Records showed that medication was counted, recorded and signed for when guests arrived and left, providing an audit of the amount of medication administered during the guests stay. Medication administration records were examined and found to be well maintained, with clear entries and no gaps. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a robust and effective complaints and safeguarding procedures, which protect them from abuse, neglect and self harm. Evidence: Information provided in the AQAA and verified at the inspection confirmed that the home has clear and effective complaints and safeguarding adults policies and procedures. As previously mentioned in this report, the procedure would be more meaningful to the people who use the service, if it was produced in a format suitable for the people for whom the service is intended, for example easy read language and pictures. The policies and procedures for the respite service and the domiciliary care services are held in one folder, whilst we were looking through these a number of polices appeared to be duplicated, however these were separate policies and procedures for the respite service and for the Domically Care Services. These need to be separated out or clearly show the distinction between the two, to prevent staff making incorrect decisions when following guidance. The AQAA states any complaint or concerns are responded to promptly to ensure a positive outcome and above all ensure that there is clear and regular communication with guests, their carers and families. Neither the service or CQC have received a complaint about this service in the last 12 months. The complaints log reflects the last Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: complaint was received in May 2008, which led to a safeguard alert being made by the manager. As a result the incident was fully investigated by the provider, who provided a full written response to the complainants and arranged for a meeting with the individual guest concerned, the relatives and the social worker to establish the best interests for the guest. The homes has an appropriate adult safeguarding policy in place, which includes clear guidance of the procedures staff must take to report allegations of abuse, including referral forms, if needed. Staff spoken with were aware of residents rights and how to refer a complainant to a senior member of staff and were clear about their duty of care and what they would do if they had concerns about the welfare of a resident. Information in the five service users Have Your Say surveys received told us, that four people do know who to speak to if they are not happy about the service they are receiving and they do know how to make a complaint, however one said they would not know who to speak with and another person told us, they would not know how to make a complaint. A relative told us, we have no concerns about the service, if did would we would be able to raise our concerns with the providers. To ensure the safety and protection of people using the service, robust recruitment procedures are in place. Staff files seen confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check, however not all staff had had a child protection check. This is further discussed in the staffing section of this report. The service is clear in their statement of purpose that they are not equipped to meet the needs of people with a history of violence, however some guests have presented behaviour that staff have found challenging, the training matrix identified that managing behaviours that challenge has been included in the rolling programme of training provided to staff, however it was not clear that all staff have completed this training to ensure they have the skills and knowledge to manage and understand behaviours that can present as challenging to others The complaints folder also contained a number of complements received about the service, these included, a thank you to the staff, many thanks for looking after our relative, they have said how much they enjoyed them self, especially going out running and for a pub lunch, quite exemplary, well done to all and thank you very much for your support, our relative really enjoys their stays at Upaya Ananda and thank you to all of you at Upaya Ananda, you are A1 in an emergency. Care Homes for Adults (18-65 years) Page 23 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout and design of the home enables guests to stay in a safe, well maintained and comfortable environment, which encourages independence. Evidence: Information provided in the AQAA and verified at the inspection confirmed that Upaya Ananda provides comfortable and warm accommodation, which is well maintained to a high standard and provides a homely atmosphere. The premises are bright, cheerful, airy and free from any unpleasant odours. It is a large modern detached house, set in its own garden and grounds, situated near the centre of Hadleigh and has good access to community facilities and services. Guests have unrestricted access around the home, with the exception of other guests rooms. All rooms are spacious, and well furnished with modern equipment and domestic style furniture, carpets and curtains. There are three single bedrooms, providing accommodation, one of which has its own hoist and an adapted en-suite shower room and toilet for wheelchair users. The guests bedrooms are nicely decorated, each with a different colour scheme and matching accessories. These have all recently been redecorated and new bedding provided. All bedrooms promote privacy, doors are fitted with door locks and guests are offered the choice of holding the key to their room, however staff hold an override key in case of emergencies. Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: Each bedroom has en-suite toilet and bathroom facilities. These are homely and include aids and adaptations to meet the needs of the people using the service, including a hospital style bed and shower bed to enable the home to care for people whose physical disabilities. There is an additional communal bathroom, and separate toilet facilities. The home has been designed to maximise guests access to all parts of the building. There is a selection of communal areas both inside and outside of the home. These consist of a large conservatory, opening up onto a decked area outside, open plan kitchen, dining and lounge area. Corridors in the home are wide enough to allow wheelchair mobility and all entrances are accessible by ramps. Appropriate aids for safe moving and handling were sited around the building. The AQAA reflects regular staff cleaning rotas have been introduced. Staff complete a daily, weekly, and monthly cleaning rota and sign to indicate that each task has been completed. Guests, their families and visitors often comment on how they like and appreciate the environment, and how clean and tidy it is. This was confirmed in information received in five service users, Have Your Say surveys received, which told us, the home is always fresh and clean and I am able to choose the room I tsay in. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding. Appropriate hand washing facilities of liquid soap and towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Care Homes for Adults (18-65 years) Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in sufficient numbers to support the guests who use this service, however they must be properly checked and trained to work with guests using the service who are under the age of 18. Evidence: The service does not provide day support, unless by prior arrangement, for example, summer holidays and sickness. The roster shows staff shift times Monday to Thursday are from 3.30pm to 9.30am to cater for overnight guests. Weekend staffing levels are adjusted to facilitate the number of guests and their choice of recreational interests. Shift times are Friday 3pm hourly to midnight, Saturday and Sundays are 7am to 5pm and Monday morning to 9.30am. Staff sleep in arrangements cover the nights. Discussion with staff and the manager and examination of the duty roster confirmed the rota is planned around the needs of guests and that staffing levels are being maintained, however, the duty roster is confusing as it covers the staffing arrangements for two of FUNs other services, Mania Ananda and Ananda. This was disused with the manager, Upaya Ananda is registered as a separate care home providing respite and the rota needs to clearly demonstrate who is working at the respite service. Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: The home operates a robust recruitment process. The AQAA identified that full staff checks are carried out prior to appointment. Staff files examined confirmed documents and recruitment checks, required by regulations, to determine the fitness of the worker are obtained prior to commencing employment. These included Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, 2 references, photographic identification, and a completed application form, which reflected the individuals career history. However, as already identified in the complaints and protection section of this report, staff need to be checked against the child protection register. This was discussed with the manager and provider, who agreed to ensure that all staff employed to work with guests under the age of 18, will have a Protection of Chidrens (POCA) check. Staff files confirmed some staff have completed child protection training and all staff had completed vulnerable adults training as part of their professional development. Discussion with staff and information received in three staff Have Your Say surveys received, told us, staff felt they are sufficiently staffed, are provided with up to date information about the needs of the guests and receive training, so that they have the skills and knowledge to meet different needs of people using service. The three staff files tracked contained certificates to reflect training they had completed, between 2006 and 2009. These included moving and handling, first aid, fire safety, food hygiene and care of medicines. Training more specific to the needs of people using the service has included epilepsy awareness, Autism, nutrition and wellbeing, Percutaneous Endescopic Gastrostomy (PEG) for people who have their nutritional needs met through a tube directly into their stomach. Staff have also attended training to make them aware of the Mental Capacity Act. Training and supervision has appeared to have lapsed for 2008/9, this was confirmed in discussion with staff, the manager and information seen on staff files. The AQAA identifies this is an area where the service needs to make improvements, the provider has contacted an outside consultant who has helped to develop a wide ranging training programme, which is being implemented by the training manager, with the aim to ensure that staff training is a top priority. Moving and handling training was observed taking place on the first day of the inspection. The Training Plan for 2009/2010 reflects a rolling rota of training that has occurred and planned. This includes specialist areas of interest, such as Total Communication, sign language and makaton, dementia and autism, as well as mandatory training such as safeguarding adults, medication updates, moving and handling, PEG, emergency first aid, infection control, epilepsy, managing behaviours that challenge, intimate and personal care, mental health and learning disabilities, mental capacity act, person centred planning and record keeping. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: The AQAA states the home employs a total of five care staff, four have obtained a National Vocational Qualification NVQ Level 2 and/or above. These figures reflect that the service has reached the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. The AQAA and staff files also confirmed that all five staff have completed the induction training expected by the NMS, Skills for Care. Care Homes for Adults (18-65 years) Page 28 of 35 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. People using this service can be confident that their views will be listened to and that their stay will be centered around their specific needs, however safety checks must be undertaken to ensure the health, safety and welfare of guests and staff. Evidence: Emma Law was appointed as the new manager of the home, in January this year. They are in the process of making an application to us, CQC to become the Registered Manager of the service. The service has a comprehensive structure with clear lines of accountability and responsibility, including the providers, a training manager, the manager and a senior care support worker, who manages the day to day activity of the staff and guests. Discussion with staff confirmed that the management team are open, honest and approachable. Staff confirmed if they have any concerns, the manager is supportive and will help out, with guests as and when required. The AQAA reflects the service continually seeks to improve the fun quality of the time spent by guests at the service. A quality assurance and quality monitoring system has been developed to seek guests and their relativies views. Each guest and their Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: relative are asked to complete a questionaire after their visit to ascertain how the service is meeting the individuals needs and goals and the aims and objectives of the service. Comments taken from samples of questionnaires completed by relatives confirmed that they are very happy about the service their relative receives. Comments included, XXX is happy joining in what ever is happening, we are happy with the service and we feel confident in the staff who keep XXX safe and secure and XXX enjoys their visits very much. Comments, seen in guest surveys included, I like my room and I feel safe during my stay, I like the food and the staff and I really like staying at Upaya Ananda because I like going out and the staff always ask me about places I would like to go. Other guests commented, I want to come and stay again, I like just being around people and just having a good time and I like staying at Upaya Ananda as the people are friendly to me and I enjoy spending time in the home, laughing and having a joke and just really having a good time. I had a really pleasant time and I enjoyed being here with my friends and the staff, I really, really enjoyed that and meeting new people. The home sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. The AQAA provides the service with the oportuinity to carry out a self assessment and inform us, CQC about their service and how well they are performing. We looked at the information in the AQAA, this did not provide us with enough information to assure us that the service was still providing excellent outcomes for guests. This was discussed with the provider and manager at the inspection, we would expect to see a lot more detail of what they were doing to exceed the standards and what further plans they have in place to further develop the service. Shortfalls were identified, which need to be addressed to ensure guests and staff have their health, safety and welfare protected. Although the most recent Gas and Portable Appliances Testing (PAT) certifiactes were seen, the five year electrical certificate expired this year and is now due for renewal. This was discussed with the provider who agreed to contact their electrician to make arrangements for inspection and testing of the fixed electrical installations in the home, in accordance with the Electrical Engineers Wiring Regulations. They have since notified us that this work is to be completed by the 31st December 2009. Also to protect people using the service under the age of 18, all staff employed to work with with them must have a Protection of Children check and the relavant child protection training. Examination of the fire logbook confirms that a fire safety risk assessment has been completed. The logbook evidenced that the fire alarm and fire fighting equipment is Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: serviced annually and that regular safety checks are undertaken, including testing the fire alarm and emergency lighting. Regular fire drills are held to ensure staff and guests are familiar with evacuation procedures in the event of a fire. Records showed that all equipment including hoists are regularly checked and serviced, including Lifting Operations and Lifting Equipment Regulations (LOLER) tests. Mania Ananda and Ananda are registered as Domiciliary Care Services (DCA), Upaya Ananda and the DCA are being run from a shared office. Fun operate a system, where certain aspects of these three services are being amalgamated. This includes staffing rotas, team meetings and policies and procedures. This however, can lead to a lack of transparency and difficulty differentiating between the services and whether resources are being allocated appropriately Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 32 18 Staff working with people under the age of 18 must have the appropraite child protection training. This will ensure the protection of people under the age of 18, who use this service. 17/12/2009 2 34 19 All staff employed to work 17/12/2009 with people under the age of 18, will need to have a Protection of Childrens check (POCA) This will ensure the protection of people under the age of 18, who use this service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Should guests whish to retain responsibility for their own Page 33 of 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations money, to protect them from the risk of financial abuse, safe lockable storage, (not the money tins currently used) need to be provided in each room. 2 42 The homes five year electrical certificate has expired this year and is now due for renewal, in accordance with the Electrical Engineers Wiring Regulations, which recommend this is undertaken on afive yearly basis. Care Homes for Adults (18-65 years) Page 34 of 35 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. 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