We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Goose Cottage Goose Cottage, Patches Farm, Norwich Road, Buxton, Norwich, NR10 5LH Date of Inspections: 04 February January 2014 Tel: Date of Publication: April 2014 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Safeguarding people who use services from abuse Staffing Supporting workers Assessing and monitoring the quality of service provision Inspection Report Goose Cottage April

2 Details about this location Registered Provider Overview of the service Jeesal D C Limited Goose Cottage is a domiciliary care service that provides support to adults with autism and learning disabilities. The service currently provides support to three people in their own homes and an outreach service for another person, in order for them to access the community from their home. The service also currently provides day care for a further 12 people, although this aspect is not regulated by the CQC. Type of services Regulated activity Domiciliary care service Supported living service Personal care Inspection Report Goose Cottage April

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Safeguarding people who use services from abuse 8 Staffing 10 Supporting workers 11 Assessing and monitoring the quality of service provision 13 About CQC Inspections 15 How we define our judgements 16 Glossary of terms we use in this report 18 Contact us 20 Inspection Report Goose Cottage April

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an announced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 29 January 2014 and 4 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. What people told us and what we found Five relatives we spoke with made comments such as, "I couldn't wish for anything better. Without them I'd be up the creek without a paddle." And, "They're a great lot. They're my battery charger." One relative told us, " has got very complex needs and is difficult to care for. What they do, I forever owe them. I know [name]'s going to be safe with them." One person we met and spent time with showed us their person centred plan and indicated they were happy with it. Two people's care records showed that their needs had been fully assessed and the information had been used to form the basis of each person's individual plans of care. The provider's policy and procedure for safeguarding vulnerable people was up to date and contained comprehensive, clear guidance for staff. The staff rotas were designed to meet the support needs of the people using the service. One relative told us, "There are a certain few that work with [name] and know [name] to a tee." In respect of staff training, some of the comments we received included: "We've had issues in the past regarding staff training but this has improved." And, "The staff are receptive but I feel that Jeesal should provide more in-depth autism training for the frontline staff. If you don't have good knowledge of autism, it will go wrong!" Other comments we received from the relatives we spoke with included: " they listen and take family advice and input ", " they listen to what I say and work well with us." Inspection Report Goose Cottage April

5 You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Goose Cottage April

6 Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement During discussions, the manager explained how support was provided for people on an individual basis, in accordance with their identified needs. The manager demonstrated good knowledge of each of the people who were being supported. The records we looked at showed that people's needs were assessed and that care and support was planned and delivered in line with their individual care plans. This was also confirmed by our observations and by discussions with relatives. We spoke with five relatives as part of this inspection and received comments back from them such as, "I couldn't wish for anything better. Without them I'd be up the creek without a paddle." And, "They're a great lot. They're my battery charger." One relative told us, "[name] has got very complex needs and is difficult to care for. What they do, I forever owe them. I know [name]'s going to be safe with them." We were also told, "They're not having the incidents they had when [name] first started. I know [name]'s mood and so do they [the staff] now." One person we met and spent time with on 4 February, showed us their person centred plan, which they indicated they were happy with. This described things that were important to them and included pictures and words showing things they liked and things that they didn't. This person also showed us around the games room, and the gardens, where we saw the horses and chickens. The person indicated that they liked the animals and we observed them helping staff to feed corn to the chickens and pet the horses. We looked in detail at two people's care records and saw that their needs had been fully assessed and we saw that this information had been used to form the basis of each person's individual plans of care, support and associated risk assessments. Inspection Report Goose Cottage April

7 The information we saw was clear, detailed and individual. It was also easily accessible by staff, providing clear guidance with regard to how each person required support, in accordance with their needs and wishes. There were detailed risk assessments in place that covered many aspects of people's daily lives. Each of these had been completed specifically for the individual they referred to and showed how risks were to be managed. All of the risk assessments we looked at were up to date and had been regularly reviewed. Some of the areas we saw that were covered within people's support plans and risk assessments included, medication, daily routines, personal care, continence, communication, interaction and behaviours that may challenge. We also looked at people's assessments of personal living skills, which covered areas such as eating and drinking, their ability to carry out domestic tasks and personal care/hygiene. We noted that people had varied but structured activities and we saw photographs in people's support plans that showed them enjoying activities such as boat trips, swimming, bowling, shopping, meals out, zoo trips, feeding the farm animals, picnics and walking. We noted that regular spot check forms were completed by the manager, to ensure people received support in accordance with their activity planners. In addition, staff completed a daily report for each person, which included details of activities undertaken, medication, food and drink consumed, general information and hand-over notes/areas of concern. We saw that where incidents had occurred these were reviewed thoroughly with the person or people involved and appropriate risk management / support plans were put in place. This told us that risks to people could be managed appropriately and that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Inspection Report Goose Cottage April

8 Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement We saw that risk assessments were in place with regard to possible financial abuse. These covered people's individual vulnerability as well as highlighting areas such as the activities budget. It was stated that the activities budget should be used in accordance with the genuine choices of the people using the service and not to suit staff. This helped to ensure people were protected from misuse of their money. We saw that where there were instances of any injuries to people using the service, these were clearly documented, body maps completed and investigations carried out where necessary. We saw that the provider responded appropriately to any allegation of abuse. For example, we saw that a thorough and detailed investigation had been carried out and an 'internal investigation report' completed, following concerns raised by an external professional. We saw that this investigation had been concluded satisfactorily. Two of the relatives we spoke with told us that, when they raised concerns or had any issues, these were now being dealt with properly. We looked at the provider's policy and procedure for safeguarding vulnerable people. This was in date and contained comprehensive but clear guidance for staff, providing definitions and examples of actions that constituted abuse. We saw that there was a clear flow chart of actions that staff must take in the event of a safeguarding incident occurring, with details of how to make a safeguarding referral and a list of the relevant people's and authorities' contact details. This showed that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One of the relatives we spoke with told us, "The manager is fantastic. There have been Inspection Report Goose Cottage April

9 failings in the past but these seem to have been sorted now." They also said, "Certain staff are good with [name], some are not so and sometimes [name] comes home stressed having said that, [the manager] is wonderful running the place right now we always get regular feedback from them." Inspection Report Goose Cottage April

10 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement We looked at the staff rotas for January 2014 and saw that these were designed specifically to meet the support needs of the people using the service. One of the relatives we spoke with told us, "There are a certain few [staff] that work with [name] and know [name] to a tee." Another person said, "We usually have the same carer all the time." We saw that the staff cover was consistent for the four weeks we looked at and gave clear descriptions of which service users the staff would be supporting. These also included times allocated for sleep in shifts and the days/times that people needed to be picked up or dropped off at various locations, such as home. In addition to the rotas, a member of staff explained the routines that were followed each day, to ensure the appropriate allocation of staff for people using the service. For example, on arrival for duty, staff would check the 'white board' in the office to see which service users were due in that day. The information showed which staff would be supporting each person and what activities were scheduled for them. It also included details about which vehicles were allocated for whose use and when. In addition to this, staff would also check the diary, memo book and their pigeon holes, to make sure they were up to date with all relevant information relating to the people using the service. We noted from the minutes of the staff meeting in October 2013 that recruitment of experienced staff was ongoing. It was also highlighted that there was a waiting list for people to access the service provided by Goose Cottage but that this could not be arranged until additional staff had been recruited. Some of the comments we received from the relatives we spoke with included: "I was a bit concerned about having other people in my home but they're all very polite and respectful. The staff are always happy and kind to me too, which is really good if I'm feeling low." This told us that the provider ensured there were enough qualified, skilled and experienced staff to meet people's needs. Inspection Report Goose Cottage April

11 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement We saw evidence during this inspection, which confirmed that staff received appropriate professional development and were able to obtain further relevant qualifications as needed. The training matrix showed that the majority of staff had completed and were up to date with training in areas such as first aid, health and safety, infection control, medication, epilepsy awareness, fire safety and safeguarding. The manager told us that the Professional Boundary and Safeguard Training was renewable every 3 years. We also saw that a number of the staff had completed training that was 'service user specific'. This included training such as Non-Abusive Psychological and Physical Intervention (NAPPI), mental health awareness, autistic spectrum disorder, nutrition and dementia. However, the provider may find it useful to note that a few relatives spoken with thought the staff should receive more in-depth training in understanding and working with people who had autism. It was highlighted that, although the provider had a number of senior staff and specialists who were highly experienced and qualified in this area, it was the front-line staff who often worked on a one-to-one basis with people that really needed this higher level of training. Some of the comments we received from the relatives we spoke with included: "We've had issues in the past regarding staff training but this has improved." And, "The staff are receptive but I feel that Jeesal should provide more in-depth autism training for the frontline staff. If you don't have good knowledge of autism, it will go wrong!" We saw that the service administrator had sent an to the provider's training department in February 2014, which requested dates for staff to attend various training courses from April to July It was stated that this was in order to 'get everyone up to date'. The records we looked at for two members of staff showed that, although they had both Inspection Report Goose Cottage April

12 received an appraisal, one person last received this in April 2013 while the other person had not had one since August We also noted that formal supervision notes were a little erratic and somewhat irregular. However, the manager told us that staff received informal support and supervision on a regular basis. Our observations during this inspection assured us that this was the case and we saw that the manager had an 'open door' policy, whereby staff could discuss any issues on a one-to-one basis at virtually any time, as needed. Inspection Report Goose Cottage April

13 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had effective systems to regularly assess and monitor the quality of service that people received. Reasons for our judgement There were a number of systems in place to assess and monitor the quality of service provided. We met with the organisation's 'Group Director of Compliance and Training' during this inspection. They told us that they visited the service on a weekly basis to monitor general compliance. They said that they also carried out regular audits for aspects of support such as medication and finances. We saw a review that was carried out in December This covered 13 areas, which included vehicle management, staff contracts, service contracts, report writing, monitoring/audits, policies/procedures and service users' activities. The results of this review showed that 12 out of the 13 area required action to be taken. We saw these areas had been reviewed again in January 2014 and noted that all but three had been actioned one of which was noted to be work in progress/ongoing. We saw that regular spot check forms were completed by the manager, to ensure people received support in accordance with their individual activity planners. We also noted that the daily reports were cross referenced against people's timetables, to ensure compliance was maintained with regard to the provider's remit for service delivery. We saw that other monitoring systems had recently been implemented. These included daily, weekly, monthly and six monthly checklists for specific areas involving service users, staff, administration and environment/health and safety. Staff gave their views on the running of the service during the formal staff meetings and we saw that minutes were kept of these meetings. It was also evident during this inspection that the manager had an 'open door policy' and actively encouraged comments, suggestions and feedback from the people using the service and their friends and family, as well as from staff and other relevant professionals. Some of the comments we received from the relatives we spoke with included: "The manager is very professional. They have the authority that's needed. They listen and take Inspection Report Goose Cottage April

14 family advice and input ", " there is very good communication between us, which is essential ", " I can easily get hold of the manager or the carer will pass anything I want back to the office. They listen to what I say and work well with us." Other comments included: "The feedback between us all is brilliant, because [name] needs structure, so it's really important that we all work together.", "There is always a full handover between us and the staff on a daily basis." And, "I would speak my mind and I can speak straight with all the staff." We saw from some of the records we looked at that staff knew how to report incidents and there was evidence that learning from incidents took place and appropriate changes were implemented as necessary. We saw copies of correspondence, which showed how some concerns that had been raised in the past, had been acknowledged and dealt with appropriately by the manager and provider. Inspection Report Goose Cottage April

15 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Goose Cottage April

16 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Goose Cottage April

17 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Goose Cottage April

18 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Goose Cottage April

19 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Goose Cottage April

20 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Goose Cottage April