Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. John Greenwood Shipman Centre 1 Farmbrook Court, Billing Brook Road, Northampton, NN3 8UW Date of Inspection: 15 October 2013 Date of Publication: December 2013 We inspected the following standards as part of this inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Cooperating with other providers Safeguarding people who use services from abuse Supporting workers Assessing and monitoring the quality of service provision Records Action needed Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 1
Details about this location Registered Provider Overview of the service Type of service Regulated activity Northamptonshire Healthcare NHS Foundation Trust The John Greenwood Shipman Centre provides short break stays for up to ten children with physical disabilities and/or complex behaviours. Hospital services for people with mental health needs, learning disabilities and problems with substance misuse Treatment of disease, disorder or injury Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 2
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 What we have told the provider to do 5 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Cooperating with other providers 9 Safeguarding people who use services from abuse 10 Supporting workers 11 Assessing and monitoring the quality of service provision 12 Records 13 Information primarily for the provider: Action we have told the provider to take 15 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This inspection was part of a themed inspection programme specifically looking at the arrangements for transition from children's to adults services. The programme focussed on young people aged 14-25 years with complex physical health needs. This was an unannounced 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 15 October 2013, 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 and talked with staff. What people told us and what we found We spoke with a person that used the service who told us they liked staying at the service and that the staff were great. When asked about the service they told us "It's like my second home". We spoke with two relatives of people that used the service. They told us they were very happy with the service their relative received. One relative told us "(my relative) has always received excellent care". Another told us "It's very professionally run". We spoke with two staff members who told us that they felt well supported in their roles and that they were always able to seek support if they needed it. One staff member told us "It's a good service that provides good support for families and carers and liaises well with other services". We found that people's needs were assessed and care plans were put in place to ensure their needs were met. We found that the provider maintained contact with other professionals involved in people's care and that people were protected from the risks of abuse. However we had concerns that records were not always updated or fully completed and there was a risk to show how risks associated with people's care had been assessed. This meant there was a risk that staff may not have the most up to date information about the needs of the people that used the service and a risk that the care they provided may not meet their current needs. You can see our judgements on the front page of this report. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 4
What we have told the provider to do We have asked the provider to send us a report by 18 December 2013, setting out the action they will take to meet the standards. We will check to make sure that this action is taken. Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take. More information about the provider Please see our website www.cqc.org.uk 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 5
Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement Staff received appropriate professional development. We spoke with two staff members that told us that they felt well supported and they had received adequate training to enable them to meet the needs of people that used the service. We looked at the training records that were kept. We found that as the provider had currently taken over the service from two different providers and all staff were attending the organisation's induction. We saw that out of 35 staff at the service, 28 had attended the induction, three staff were off on long term sick and four staff were booked on the induction in November. We found that not all staff had attended all relevant training to enable them to meet the needs of all of the people that used the service. We discussed this with the manager of the service who told us that this had arisen as two services had joined to become one under a different provider and differences in training requirements and techniques had been identified. The manager told us how they allocated staff accordingly to meet people's needs and how staff did not work with people until they had received the relevant training. We saw there were plans in place to address the consistency of training. We spoke with a staff member who confirmed that they were not asked to work with people if they did not have the training to meet their needs. We spoke with a person that used the service who told us that their care was provided by staff that had relevant training to meet their needs. We looked at the staff records that were kept for five people that worked at the service. We found that all of the staff had received supervision. As the service was newly registered there was no evidence of appraisals but we saw there were plans in place to begin to carry them out. From time to time staff were able to obtain further relevant qualifications. We were told that three staff members were enrolled to complete their Diploma in Children's Workforce and that all other staff at the service that provided care and support had already achieved this. We spoke with one staff member who told us they had completed a level three Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 6
qualification in Childcare. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 7
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 People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the care records of three people that used the service and we found people's needs were assessed and a care plan had been put in place to ensure their needs were met. We found that care records provided staff with information about how they should provide care and support to ensure that people's needs were met. We observed a person that used the service being supported as detailed in their care plan. We spoke with a person that used the service who told us about the care and support they received and it was consistent with their care plan. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that risks had been assessed and control measures had been put in place to ensure risks were reduced. We found that people's care records contained information about their medication and emergency contact numbers should they be needed. We found people that used the service attended school or college during the week but there were other activities and outings offered to people in the evenings and at weekends. We saw during our visit people that used the service being asked if they wanted to attend a disco that evening. We spoke with a person that used the service who told us that staff supported them to go out shopping because that is what they wanted to do. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 8
Cooperating with other providers People should get safe and coordinated care when they move between different services Our judgement The provider was meeting this standard. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. Reasons for our judgement People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. We saw evidence of staff from the service attending the reviews of people that used the service and producing reports to share as appropriate with other providers. We saw that the provider made contact with relevant social workers to provide feedback and share any relevant information relating to people's care and treatment. We spoke with two relatives of people that used the service who told us the provider was in contact with other professionals involved in their relatives care and how a representative from the service attended and contributed to their relatives' annual reviews. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 9
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 use 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 People who use 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. We looked at the provider's policy for safeguarding. We found that it contained detailed information about abuse and people's roles and responsibilities under the policy. We saw that it provided people with a clear procedure to follow if they suspected abuse and contact details of where they could report abuse to. We found that all staff members had attended some training in safeguarding and that staff at more senior levels within the organisation had attended more complex training. We spoke with two staff members who told us about the actions that they would take if they suspected abuse and they were consistent with the policy. Staff also told us where they were able to access the safeguarding policy should they need it. We spoke with a person that used the service who told us they felt safe while staying at the service. We spoke with two relatives of people that used the service who told us they felt their relatives were safe at the service. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 10
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 Staff received appropriate professional development. We spoke with two staff members that told us that they felt well supported and they had received adequate training to enable them to meet the needs of people that used the service. We looked at the training records that were kept. We found that as the provider had currently taken over the service from two different providers and all staff were attending the organisation induction. We saw that out of 35 staff at the service, 28 had attended the induction, three staff were off on long term sick and four staff were booked on the induction in November. We found that not all staff had attended all relevant training to enable them to meet the needs of all of the people that used the service. We discussed this with the manager of the service who told us that this had arisen as two services had joined to become one under a different provider and differences in training requirements and techniques had been identified. The manager told us how they allocated staff accordingly to meet people's needs and how staff did not work with people until they had received the relevant training. We saw there were plans in place to address the consistency of training. We spoke with a staff member who confirmed that they were not asked to work with people if they did not have the training to meet their needs. We spoke with a person that used the service who told us that their care was provided by staff that had relevant training to meet their needs. We looked at the staff records that were kept for five people that worked at the service. We found that all of the staff had received supervision. As the service was newly registered there was no evidence of appraisals but we saw there were plans in place to begin to carry them out. Staff were able, from time to time, to obtain further relevant qualifications. We were told that three staff members were enrolled to complete their Diploma in Children's Workforce and that all other staff at the service that provided care and support had already achieved this. We spoke with one staff member who told us they had completed a level three qualification in Childcare. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 11
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 an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. On the day of our inspection we saw a relative's forum meeting was taking place. This provided relatives of people that used the service an opportunity to meet, provide feedback and offer comments and suggestions about the service. We spoke with the manager of the service who told us that following feedback from the relative's forum a service Facebook account had been created with restricted access for only relatives and people that used the service to enable them to keep up date with activities and events taking place at the service. We saw a comments card that was given to people to complete at the end of their short stay. It was produced in an easy read format to meet people's needs. This showed the service asked people for their views about their care and treatment. We found that in one person's care records an e-mail from their relative had been received by the service where they had raised a concern. We spoke with a staff member who told us about the actions they had taken in response to the concern. We saw a quality monitoring audit was carried out on a quarterly basis that looked at how the service was meeting each of the outcomes from the essential standards of quality and safety. We looked at the quality monitoring audit that had recently been completed for the service and we saw an action plan had been put in place to address any areas where improvements were required. We saw that each action point had a nominated member of staff who was responsible for the action and a clear timescale of when the action should be completed by. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 12
Records Action needed People's personal records, including medical records, should be accurate and kept safe and confidential Our judgement The provider was not meeting this standard. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We have judged that this has a minor impact on people who use the service, and have told the provider to take action. Please see the 'Action' section within this report. Reasons for our judgement Records were kept securely and could be located promptly when needed. We found that records were locked away but staff were able to access them when they needed to. However, people's personal records including medical records were not always accurate. We looked at the care records for a total of three people that used the service. We found there were some areas of records that had not been fully completed or updated which meant that staff may not have the most up to date information about the needs of the people that used the service and a risk that the care they provided may not meet their current needs. We found that one person's admission procedure assessment had not been fully completed and there was no record of their general health or current nutritional needs. This was important as people only used the service for a short period of time and so staff needed to be sure at the start of people's stays that they recorded and received up to date information about people's needs. There was not an up to date record of this person's general health. In another person's admissions assessment we saw they had brought some money with them into the service the day before our inspection. We looked at the person's money audit and we saw that the last transaction on there had been recorded approximately six weeks prior to our visit. We looked at the persons daily records of when they had stayed and we saw the day prior to our visit it was recorded that they had visited the shops and spent some of their pocket money but the financial transaction had not been recorded anywhere. This meant that people's money was not protected as there was not a clear and accurate record of financial transactions that took place. We looked at the care records of another person that used the service and spoke with staff about their needs. Staff told us that the person had been into hospital for an operation which had an impact on the way staff carried out their care. We looked at the care records and were not able to see that the change in the person's needs had been recorded and manual handling plan had not been updated to reflect the change in the person's needs. A staff member told us about how they now provided their care but their care plan had not Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 13
been updated to reflect the change. This meant there was a risk that whilst staff we spoke with were aware of the up to date information and care that should be provided the lack of an accurate record meant there was a risk that the information was not known to all staff that needed to know. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 14
This section is primarily information for the provider Action we have told the provider to take Compliance actions The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards. Regulated activity Treatment of disease, disorder or injury Regulation Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010 Records How the regulation was not being met: Service users were not protected from the risks of unsafe or inappropriate care and treatment as accurate records were not maintained. Regulation 20 (1) (a). This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider's report should be sent to us by 18 December 2013. CQC should be informed when compliance actions are complete. We will check to make sure that action has been taken to meet the standards and will report on our judgements. Inspection Report John Greenwood Shipman Centre December 2013 www.cqc.org.uk 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 2009. 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 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 2009. 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 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 2009. 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 20
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk 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 John Greenwood Shipman Centre December 2013 www.cqc.org.uk 21