Inspection on 16/05/08 for Twyford House

This is the latest available inspection report for this service, carried out on 16th May 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Twyford House 26/09/06

Twyford House 19/12/05

Twyford House 25/07/05

Twyford House 17/02/05

Twyford House 10/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Twyford House Whitfield Avenue Dover Kent CT16 2AG Lead Inspector Kim Rogers Unannounced Inspection 16th May 2008 08:30 Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twyford House Address Whitfield Avenue Dover Kent CT16 2AG 01304 241804 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) twyford.house@robinia.co.uk The Robinia Care Group Ltd Mrs Jayne Anne May Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th May 2007 Brief Description of the Service: Twyford House is part of the larger Company of Robinia Support Solutions, and is registered to provide accommodation, support and personal care for 13 younger adults with a learning disability. The premises are a purpose built detached property. All service users have their own bedroom. It is situated on the outskirts of Dover in a residential area near to local shops with easy access to the main bus route to the town. The local church and pub are within walking distance from the home. The home also has its own transport. The fees for living at this home range from about £1,615 to £2,038 per week. For more information about this home and what the fee covers please contact the Provider. Previous inspections reports are also available from the Provider. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 16 May 2008 between 08.30am and 12.40pm and is part of the key inspection. The Registered manager, Jayne May, service users and staff assisted with the process. The inspection process consisted of information collected before and during the visit to the home. Records were sampled including assessment and person centred plans, medication and activity records. Some service users gave face-to-face feedback. A service user showed the inspector their room and other parts of the home. Organised and spontaneous activities were taking place throughout the visit, and observations formed part of the evidence collected. The manager completed the AQAA (Annual Quality Assurance Assessment). This gives information about how the home has improved and how the home intends to improve. The AQAA was well completed and gives good evidence of what they do well, what could be improved and how they intend to improve. Service users said ‘it is better now I do my own medication, I don’t have to be with 2 staff’ ‘I like it here’ ‘I get on with people better now’ ‘I have my own key to the front door now’ The requirements and recommendations made at the last inspection have been met. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. What the service does well: Most people say the home is usually clean. The home was clean during the visit and service users are supported to keep the home clean. This helps to develop their skills and gives people some responsibility. The manager and most of the staff are long standing and there has been little change in staffing since the last inspection. This means that they know service users well and gives consistency. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Care planning has been reviewed so plans are person centred and detailed. Everyone either has a person centred plan or is working on one. Plans are individual and meaningful to people and everyone has been fully involved. Personal goals for the future are recorded and regular review checks to see if people have the right support to achieve their goals. A new behaviour support plan based on positive approaches has been developed and staff are in the process of implementing these with individual service users. Person centred planning and a positive approach to supporting challenging behaviours training is now mandatory for all staff. Risks are now managed without restricting people but with a focus on enabling people. This has lead to one person going to the local shops independently. This has all lead to a decrease in the amount of incidents involving challenging behaviour and in turn has lead to increased opportunities and increased quality of life for service users. For example the number of tutors being brought into the home has decreased as people can now access community based tutors. There has also been a reduction in medication for some people and increased community presence. The use of restraint (at most, support holds are used) has reduced- 24 incidents in the last 12 months compared to over 240 incidents in a previous 12 months. Restrictions have been reviewed and removed giving service users more control oven their environment. Some people now have a key to the front and back door and kitchen. Bathrooms and toilets are no longer kept locked because they have flood alarms, which are less restrictive. The manager has nearly completed the first year, Certificate in Person Centred Support, of a three-year course at the Tizard centre, University of Kent at Canterbury. The manager has transferred her learning about person centred support to the staff team. Service users are having the support they need to take more control of their health and medication. Communication has been improved by way of training and the introduction of an evening and weekends choices board that service users helped to make. This means that service users have the support they need to make choices and decisions. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use the service experience good outcomes Information about the home is produced in different formats so people have the information they need to make a decision about the home. People know that their needs and future goals will be assessed to make sure the home can support them properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective service users are given lots of information about the home, including a newsletter ‘ Twyford Times’ produced by service users and staff. This helps people make a decision about moving in. Trial visits and stays are arranged individually to meet peoples’ needs so they get a feel of what life is like at the home. Compatibility with other people is considered carefully. A service user who has just moved in said they had a look around before they decided to move in. Service users now have a detailed baseline assessment, which they have had lots of say in. This has established each person’s hopes and wishes for their future, as well as support requirements. Prospective service users have a very detailed assessment that will form their basic care package. An assessment was sampled and showed that the service Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 10 user was fully involved and kept at the centre of this process. Where possible families are involved in the assessment process. The AQAA says that they plan to improve the information about the home and make it more user friendly. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good outcomes Person centred approaches put service users at the centre for all consultation and planning, decision-making and risk taking. People are achieving their goals and starting to live the lives they want due to good support and person centred planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have been fully consulted in the development of their person centred plans. Plans are all individual so they mean a lot to the people who they are for. Everyone either has a plan or has started to develop one with staff. Personal goals and aspirations for the future are recorded and kept under review so staff know if people are getting the right support. As a result one person is planning to move to a smaller home and others are taking more control of their lives for example taking control of their money and medication with the right support. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 12 Positive behaviour support plans have been developed with service users where necessary. This means that staff use positive approaches to manage problem behaviours. With staff being more proactive incidents and the use of restraint have reduced. Risks have been assessed with individuals with much more focus on enabling people and giving them control. Risks are being reviewed regularly to be certain that only absolutely necessary restrictions are imposed. Service users are having more freedom and problematic behaviours are seen differently as a consequence of this new approach. The staff team have had training in person centred planning and positive behaviour support and there is now real equality between staff and service users. Staff should continue this good start to ensure that all service users have a meaningful plan to support them to lead the life they want. Improvements have been made to support communication. For example staff attend Makaton (sign language) training and now hold in house sessions every week with service users to develop and practice their Makaton skills. This means that service users have the support they need to make decisions and choices. The AQAA says that they plan to continue to develop and fully implement person centred planning for all service users. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 People who use the service experience good outcomes Service users have real opportunities to develop and have the lifestyle they choose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are considerable improvements to service user lifestyle. People can learn and maintain their life skills. For example, most people now access the kitchen regularly and have developed their cooking skills. As a consequence of reviewing approaches to lifestyles, relationships between staff and service users have improved. There is a more equality. Service users are happy with the changes, environmental restrictions have dramatically reduced and the level of aggressive incidence has dropped significantly. The number of tutors being brought into the home has dropped as people now access community based tutors and courses due to less problem behaviour. People have much more control over their lives. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 14 Each person has a weekly activity planner covering Monday to Friday, which has symbols showing the activities. There is now a board for evenings and weekends that service users helped to make. This gives service users a choice of activity and is user friendly. The home has a vibrant and happy atmosphere, and a real ‘buzz’ about it. Service users are now more involved in the day to day running of the home and therefore have more responsibility and ownership. Relationships are supported with people having support to keep in touch with family and friends. Families are involved in review meetings and in developing person centred plans. There is a new cook in post who involves service users in planning and preparing meals. A board shows pictures of what is for breakfast dinner and tea so service users know what the choices are. We found that people are supported to do as much for themselves as possible. For example one person was supported to make toast, porridge and tea for their breakfast. Staff used active support techniques to enable the person to do as much for themselves a possible. Now the kitchen is open people can get drinks when they want them. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good outcomes. People have support they need to take more control of their personal care, health and medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported in the way they want, and this is spelt out in the person centred plan. Everyone has or is in the process of having a health action plan that they have been involved in developing. This easy read document helps service users take more control over their health. Staff support people to understand it, and make sure that people see the doctor etc when needed. Some service users now make their own doctors appointments giving them more responsibility and control. The staff make referrals for specialist health care support when needed. Medication administration records and systems are easy to use and show no errors, storage is safe. Staff support service users to learn how to administer their own medication and some people now have control over their medication keeping it securely in their rooms, giving a sense of pride and achievement. One person said having their medication in their room is much better than Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 16 coming to the office with two staff present. All is clearly risk assessed with regular review and monitoring. There are plans for more service users to have control over their medication. Medication administration was observed and is safe so service users are protected. Staff have training in health matters, specifically relating to service users needs and medication. The medication policy has been reviewed since the last inspection. The AQAA says that they plan to improve by giving people more control of their health and medication. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes. Service users know that their complaints will be listened to and acted on. Service users are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints policy and procedure, which has some symbols and pictures making it more accessible. Staff have been working with a speech and language therapist to improve the procedure so it is more user friendly. This means that service users will have the support they need to say if they are not happy about something. There have been three complaints from neighbours since the last inspection that the manager has responded to as required. There is a policy on whistle blowing and safeguarding vulnerable adults; both have been reviewed since the last inspection. Staff attend training in safeguarding so they know how to recognise and respond to possible harm and abuse. The manager is aware of her role and responsibilities regarding safeguarding adults. A new member of staff spoke with knowledge about what they would do if they were concerned about practice and they knew about the whistle blowing and safeguarding polices. The use of restrictive physical intervention has stopped with staff using more positive person centred approaches to supporting challenging behaviours. This has reduced the number of incidents and has improved people’s quality of life. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes. Service users live in a clean safe home that is well maintained. Service users now have more say about the home and have some control over the environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in good decorative order and has comfortable furniture throughout. A service user showed the inspector their room that is highly personalised making it feel like home. Service users have support to clean their rooms and there is a rota for other chores like wiping over the tables. Staff were observed supporting people to take part in cleaning the house giving people responsibility and developing skills. Access to the kitchen, bathrooms, toilets and rear garden is now unrestricted for most service users. Consequently, people are using the areas more, and this has added a broader dimension to the home. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 19 Service users now have keys to the front door and are happy about this. Service users were observed opening the front door to callers giving them more control of the environment. A housekeeper is employed and all communal areas are clean and tidy throughout. The AQAA says that the home has improved by installing magnetic curtain poles. This means that curtains can be put back up easily and quickly if they are pulled down. There are plans for a new back fence and planting trees will give more privacy. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good outcomes Service users can feel certain that the staff team will understand and support their needs, and that staff have had all the necessary safety checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Changes in care planning has allowed newer staff to get to know the people better in a shorter time period – which removes stress levels for service users. A new member of staff spoke with knowledge about service users needs. They spoke about their comprehensive induction, which includes achieving the Certificate in Working with People with a Learning Disability (CWPLD). Training is more focused around service users needs and person centred support. The staff team can therefore meet the current service users specific needs. Staff numbers are provided to meet service users planned activities. The length of shift has been reduced from ten hours to eight hours with a longer handover period. This means that staff are less tired and better informed about service users changing needs. At handover staff said there can be up to 10 staff, which enables more one to one support. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 21 Recruitment processes are solid and gather all the data necessary to make sure service users are protected. Prospective staff have a trial day at the home. A new staff member said their trial day ‘was really good’ Service users know who is on duty as there is a board showing staff photos. The AQAA says that there are plans to support service users to be part of the staff recruitment process. This means they can have a say about who might potentially support them. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good outcomes. The home is run in service users best interests. Service users know their health and safety will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has improved the service since the last inspection, improving outcomes for service users. The manager has lead and promoted person centred planning, which has decreased the amount of challenging behaviour incidents therefore improving service users quality of life. People are starting to have more control over their lives. The manager has nearly completed the first year ‘Certificate in Person Centred Support’ of a three-year degree course at the Tizard Centre, University of Kent Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 23 at Canterbury. The management of the home has been stable since the last inspection. The AQAA showed and we found that there is a range of ways that service user’s views are sought. Changes and improvements to the home have been made following suggestions by service users. There are regular audits by all parts of the organisation including health and safety and training. An area manager carries out monthly visits and there is more of a focus on outcomes for service users at these visits. The AQAA showed that the required health and safety checks are carried out. They plan to include service users in carrying out health and safety checks to give people more responsibility and skill. Staff are trained in areas relating to health and safety. Incidents and accidents are recorded and reported, as they should be. The AQAA shows a good understanding of equality and diversity issues and gave good evidence of why the home is value for money. The manager, who completed the AQAA has awareness of what needs to improve and how to do it. She has identified barriers to improvement and has strategies to overcome the barriers. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA40 YA24 YA12 Good Practice Recommendations Ensure that policies and procedures are produced in formats that service users can understand. Consider, after consultation with service users, planting trees in the back garden to give more privacy. Consider, after consultation with service users, making weekly activity planners more individual so more meaningful to people. Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Twyford House DS0000023595.V363346.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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