Care Home: Valmark House

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Valmark House 90 Mill Road Colchester Essex CO4 5LJ The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sara Naylor-Wild Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Valmark House 90 Mill Road Colchester Essex CO4 5LJ 01206853539 01206843367 broadhzn@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Broad Horizons Limited Name of registered manager (if applicable) Mrs Jean Brown Fleming Revelle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: Date of last inspection 1 8 1 2 2 0 0 6 A bit about the care home Valmark House is an established small care home, for four young adults with learning disabilities, first registered in November 1998. Valmark House is found in a residential area of Colchester, located close to Colchester General Hospital. There are local shops and facilities nearby, with the main town centre offering shopping and leisure facilities a short bus ride away. 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home we checked information received by the Commission for Social Care Inspection (CSCI) since the last inspection, looking at records and documents at the care home and talking to the care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in August 2008, was considered as part of the inspection process and a tour of the premises was completed at the visit to the home. What the care home does well The home finds out lots of information about people before they move to the home. Everybody has a care plan that tells staff how they like to be supported. Helps people get out to do activities that they enjoy. Looks after peoples health and cares for them well. The home is clean and people can move around What has got better from the last inspection They make sure staff are the right kind of people to work at the home. Staff meet often with the person in charge to make sure they are doing a good job. What the care home could do better They could carry on making care plans better. Carry on improving risk assessments It would help staff to look after people better if they had more training. They need to know how to help people in the best way. Staff need more training in how to protect people. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sara Naylor-Wild CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People considering moving into the home can be assured that their needs will be assessed prior to any agreement to offer a place. Evidence: Although the service had added a room to the registered premises, there had been no new admissions to the home since the last inspection. The three people living at the home had all been resident for some time and the most recent documents relating to admission were dated September 2006. These documents were assessed at the registration of the new accomodation and judged as having sufficient information to ensure the service understood the needs of the prospective resident. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the service cannot be confident that all their needs are understood and documented by staff to ensure they are supported to achieve identified goals in a consistent manner. Evidence: There were care plans in place for all three people living at the service, and these were considered at this visit. The plans documented most aspects of the individuals daily living needs. Not all the people living at the home are able to participate in completing their plan, although where possible this was done and families’ views were also included in the consultation. The way in which the plans gave instruction to staff in meeting peoples identified needs required further development. For example in one plan it identified that the person needed to develop their skills in budgeting their money. There was not however any instructions or plan for staff to understand how this was going to be achieved. In another area it stated that the person could mistreat animals, and although there were pets in the house, there was no instructions to staff in how they were going to monitor this or work with the person to improve their responses. The plans were reviewed regularly both in informally by staff in house and through formal professional reviews that had been carried out by the persons social worker. Where possible family supporters had also been involved in the processes and their views included in the feedback of the persons progress. In one example it was documented in the persons review notes that they were assessed as having benefited from the care and support offered by the service. Evidence: There were risk assessments in place for some aspects of peoples daily lives such as road safety and cooking. These provided some indications of the considerations staff needed to make in maintaining peoples health and wellbeing whilst carrying out these tasks. There were some assessments that were not as clear and in one example the assessment for one person stated that there were minor risks associated with their going out unaccompanied. However from discussions with staff working during the inspection, this assessment of the risk level appeared to be more optimistic than they experienced in supporting the individual. The action plan element of the most of the risk assessments were brief and did not always provide specific information about how the staff were to work with the person to reduce the risks. In most cases the action plan instructions indicated that the person would need support from staff, but did not set out how this was to be provided. As stated at the previous inspection staff need to develop their skills in assessing risk appropriately. Some of the language used in the care plans did not meet the expectation of current good practice in that it was judgmental rather than descriptive. This does not demonstrate a respectful approach to understanding peoples capabilities and how these should be supported. For example in one plan it stated that someone was lazy in respect of housework and personal care. Records were maintained by staff in respect of choices of activity, menus and meal choices. These records help staff to understand how the person is progressing in achieving these goals, and is used for these purposes as a monitoring tool in reviews. There were not daily records maintained against the other outcome groups in peoples plan of care. Without this information it is difficult to understand how well the plan is working and to enable staff to monitor whether peoples needs are changing. Staff spoken with during the inspection stated that they had been advised at previous inspections that it was not appropriate to maintain a daily record for each outcome group in each persons care plan. There are not specific requirements to maintain daily logs in the Care Homes Regulations 2001. However it does state in the Commissions guidance logs available on the CSCI professional Internet pages that daily records are a good source of evidence to show that care is being provide as detailed in the care plan. Well written daily records help ensure a consistent approach and good quality of care for people using a service......detailed daily records will help the manager to audit the care being provided and make sure that staff are following care plans. It is in the homes interest to be able to show what they have done, as well as providing evidence for the review. This was discussed with the staff on duty. The files that contained the documentation relating to each person were very large and full. Some of the documentation held in them were either historic or related to the service’s general policy and procedures such as missing persons policy. This made the Evidence: files very bulky and difficult to negotiate through and it was suggested to staff that a review of the files was conducted to ensure that only documents that related to the person’s current needs was kept in the file. Other documents required either to be archived or to be held in separate files. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home can be assured that they will be provided with some opportunities to take part in activities and the local community and that they will be supported in their relationships with their family and friends. They cannot be sure that staff will always have the skills and abilities to support them in this part of their daily lives. Evidence: There had not been any changes to the group of people living at the home since the last inspection. From assessments and other documents it is clear that none of the people living at the home are able to gain employment outside the home. The range of activities people participate in are to some extent determined by their abilities and behaviour. This ranged from engaging in a number of community based activities to very few activities outside the home. There are activities records maintained by the staff to indicate how people spend their time. Staff spoken with during the inspection stated that engaging some people in activities tested their skills and experiences. One persons review notes indicated that they enjoyed gardening, shopping, country walks, visiting the zoo, meals out and car trips. Although there are further entries that state the person was reluctant to go out and was not enjoying the short walks staff Evidence: tried to arrange. There was not a further strategy in place to address this and staff spoken with during the inspection acknowledged that whilst they continually attempted to engage people in activities they faced a challenge in engaging some people. All the people living at the home were encouraged to maintain links with their families. This is supported by the service to the level that the person wishes. Communication between the service and the families of people living at the home was good. People moved around the home freely during the inspection visit, with people accessing the communal rooms as well as their personal space. Staff spend a great deal of time at the home, and as such are relaxed in their routine and appearance whilst working. This relaxed and casual atmosphere provided benefits to people living at the home. It meant that the routines were not rigid and that staff interacted with people on an informal basis. There were however some indications during the visit to the home, that staff may have lost sight of who the service is focused on. In two examples during the visit it was observed that the staffs preferences had been followed rather than those of the people living there. In one instance the television was tuned to a music station, and when asked whose music choice the selection was, we were informed it was the staff members and not the person sitting in the room. It was also noted that whilst none of the people living at the home are recorded as smokers, there was a strong odour of tobacco smoke in the home on our arrival. 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 . People living at the service can be confident that their health care needs will be monitored and appropriate steps taken to access healthcare support should it be required. Evidence: The homes arrangements for supporting the healthcare of service users was unchanged from the previous inspection when they were found to be satisfactory, with the record keeping and medication administration well managed. All service users are registered at a local GP surgery. There is access to local healthcare facilities such as the dentist, which has moved from the centre of Colchester to the immediate locality. Links with a consultant psychiatrist and the outreach team are encouraged and service users are supported by the home and their relatives to attend regular review appointments. The way the service manages Medication records and medication was considered again at this visit. Medication was held and securely stored in a wall cupboard in the first floor room that had previously been an office. This was in the process of being changed into a quiet room for people living at the home to use and therefore the medication storage was being relocated to a more appropriate position in the home. The records and system of storage of medication were good and this included controlled drugs administration and storage. Staff administering medication had received training appropriate to the task. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the service can be assured that there are systems that should encourage staff to listen to their concerns and take action to protect them. They cannot be sure that the staff’s knowledge has been supported by training in safeguarding vulnerable adults. Evidence: The service has a complaints policy in place that sets out how people can make complaints. The policy is in line with the recommendations of the Care Homes Regulations 2001. The service does not maintain a complaints log and the staff were not aware of any complaints received in the previous 12 months. The people living at the home do not all have literacy skills and alternative formats of the complaints procedures were not available at the time of the inspection. In order to ensure that everyone can access the complaints procedures as fully as possible the service should consider suitable formats in which to present information such as the complains procedures. Some people spoken to during the visit to the home were confident that they could speak to someone if they did not like anything. They identified who this was and said they would sort it out. The service has a safeguarding policy and procedure that refers to the guidance from Essex County Councils Safeguarding unit. This includes the indications of abuse and how the staff and service should respond to allegations made about vulnerable adults sustaining abuse. This would provide staff with information about how an allegation of abuse should be responded to and who were the lead agency in responding to such allegations. The staff files seen during the inspection did not indicate that training had been provided in safeguarding vulnerable adults in the previous 12 months. Although the supervision notes of one person who had started working at the service in this time Evidence: indicated that they had been told to read the policy as part of their induction. It is important that all staff receive regular updates of training in protecting people from abuse and are able to consider objectively what constitutes abusive practice. Whilst there were not evidence of serious abusive behaviour seen at the service, some of the practice identified in areas such as the language used in reports and the conduct of staff in promoting individuals choices, indicated a lack of understanding of peoples rights and how these may be infringed. 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 . People living at the home benefit from a small homely environment that meets their needs. Evidence: The premises of Valmark continue to provide a homely, clean and bright environment for people to live in. The building is a domestic house in a residential area of the local community. There had been an additional bedroom added to the building in a loft extension that had been registered for use with the Commission earlier in the year, although there had not been anyone admitted to the room since its registration. People move around the home freely and identify clearly what areas of the home are their personal space and communal space. 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 . People living at the service can be confident that the staff have skills to meet some of their needs, although this could be developed further to enhance the quality of the support they receive. Evidence: The service is staffed by a small staff group of four who share responsibility for the 24 hour rota. There were two staff on duty during the waking day, with one person sleeping overnight. The files of two staff were considered at this visit they contained evidence of a robust recruitment process. This included seeking fully completed application forms, two written references and checking the person against the Criminal Records Bureau (CRB) and Department of Healths Protection of Vulnerable Adults (POVA) list. These steps support the service in ensuring that people they employ are suitable to work with people who are vulnerable. The files also contained some certificates for staff training that staff had attended and information about courses that they were booked to attend. This included first aid, food hygiene and moving and handling. There was not a formal annual training programme in place, although staff spoken with were confident that they would be able to access any training they identified. A formal plan would provide better evidence of how the service identifies shortfalls in staff skills against the assessed needs of people living at the service and how it plans to address these Individual staff supervision notes were held on both the staff files seen. These were carried out monthly and mainly identified a topic of discussion for each month, along with any training that the person might require. The quality of supervision should continue to be reviewed to ensure that the process provides the best outcomes for staff in delivering their service to people living at the service. 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 living at the home can be confident that the service is led by a competent and skilled manager. Evidence: Mrs Ravelle, the registered manager of the service is an experienced manager. At the last inspection she had completed her National Vocational Qualification Level 4 Managers Award. The service’s quality assurance systems were not inspected at this visit, and in the absence of the manager were not discussed. Quality assurance is an integral part of how services understand what people who use them think of their performance and how they can seek to improve the quality of their service delivery. The certification of annual health and safety checks and maintenance visits were examined at this visit. These included electrical safety, gas safety, fire safety equipment and fire drills. These were all present in good order and in date. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 20/02/2007 (4)(b)(c)14(2 ensure that staff enable ) service users to take responsible risks, ensuring that they have good information on which to base decisions within the individual service users? care plan, risk assessment and risk management strategies. 2 35 18(1)(c) The registered person must ensure that there is a staff training and development programme, which meets Sector Skills Council workforce training targets. 20/02/2007 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 Peoples individual care plans 31/07/09 must contain detailed information about how staff should support their identified needs. This enables the staff to provide consistency in the way they support individuals. The way in which peoples choices are made including how they are supported to manage finances must be documented and reviewed. This ensures that staff are clear about the most appropriate way in which to support people. 31/05/09 2 7 15 3 16 12 Staff working at the home 30/04/09 must ensure that the respect the rights of people who live at the home and that they promote their choices. Staff must be able to protect the rights of people. People living at the service must be supported in accessing information in 31/05/09 4 22 15 ways that meet their assessed communication needs. People living at the home must be able to access information in what ever format that suits them best. This ensures they are able to make choices with the best information. 5 23 13 Staff must be able to 30/04/09 demonstrate competence in their understanding of safeguarding issues, through training or other means. Staff must supported by regular training in understanding how to protect people from abuse, as well as access to the written policy. They must be able to demonstrate their understanding of safeguarding. In order to provide a quality 31/07/09 of support to people living at the home the Staff training must reflect a mixture of the required elements of health and safety knowledge, their individual skills deficits and the assessed needs of the people living at the home. In order to support people living at the service, staff must have the range of skills that meet the assessed needs of those people. 6 32 18 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 35 An audit of staff skills and shortfalls would support the service in identifying how to plan the annual training programme. 2 36 Staff supervision should support staff in understanding the elements listed in 36.4 of the Care Homes for Adults (1865) National Minimum Standards. This will support staff in understanding their role within the organisation and keep them updated on professional developments within the sector. 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