Inspection on 18/01/06 for 1-2 Downer Court

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-2 Downer Court 20/07/07

1-2 Downer Court 02/08/06

1-2 Downer Court 05/07/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1-2 Downer Court 1-2 Downer Court 1-2 Downer Court Wilson Avenue Rochester Kent ME1 2SA Lead Inspector Sue McGrath Unannounced Inspection 18th January 2006 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 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 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 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. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 1-2 Downer Court Address 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) 1-2 Downer Court 1-2 Downer Court Wilson Avenue Rochester Kent ME1 2SA 01622 769100 MCCH Society Limited Ms Tracey Vivenne Mateer Care Home 7 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: 1-2 Downer Court provides accommodation for seven residents with learning disabilities and high dependency needs. All of the accommodation is situated on the ground floor and has attractive gardens to the rear of the property. The home is located in a residential area close to shops and local amenities. The Registered Provider from the 01-04-05 is MCCH Society Ltd. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection under the terms of the Care Standards Act 2000 took place on the 18th January 2006 between 14.00 and 16.30. One inspector was in the home and the main focus of the inspection was on the progress of the home in meeting with requirements made at the last inspection, the general environment and the well being of the residents. During the inspection documentation and records were read. A tour of the building was undertaken and some of the residents were spoken with. Time was also spent talking to staff and members of the management team. As this report was made following an unannounced visit and may not cover the standards in sufficient depth for the reader to make a judgment about the home, it is recommended that a copy of the last announced inspection report dated 5th July 2005 be also obtained. What the service does well: What has improved since the last inspection? The home has benefited from a programme of re-decoration and this had improved the general environment. Some of the bedrooms had also been decorated. Some new furniture had also been purchased. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 6 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. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 7 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 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 Prospective service users are currently not provided with the information they need to make an informed choice about moving into the home. EVIDENCE: The home could not produce a current Statement of Purpose or a completed Service User Guide. The manager is reminded that this was a requirement from the last inspection and must now be treated as a priority. No change was reported in the contracts and this will also remain as a requirement. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Judgement from the previous inspection. Service users have clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Care plans are regularly updated to ensure changes are recorded and acted upon. Service users are enabled to take reasonable risks within the homes risk assessment management strategies. Service users privacy is protected by a confidentiality policy that staff are familiar with. EVIDENCE: These standards were assessed as met at the last inspection. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 17 Residents benefit from having the opportunity for personal development with their daily living skills, however staff shortages mean that appropriate levels of leisure activities are restricted. Residents also benefit from being part of the local community. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Issues with accessing the residents’ monies were causing certain activities to be curtailed. The residents benefit from the appetising meals and balanced diets offered by the home. EVIDENCE: Standards 11,13,15,16 and 17 were assessed as met at the last inspection. Issues with accessing resident’s monies had resulted in residents having to endure restricted activities. MCCH had arranged a temporary loan system but this was insufficient as it was only available in limited amounts. A lot of discussion had taken place between banks, Medway’s Social Services Financial Affairs Department, Care Management MCCH but a solution had still not been 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 11 found. This situation had been continuing since April 05. A solution needs to be urgently found to ensure the residents are not at a disadvantage. Meals were offered three times a day with a range of snacks and drinks being available at all times. Menus were varied and normally chosen by a different service user each day. No evidence could be found of any nutritional assessments being carried out as required from the lost inspection. Residents were still not being weighed regularly, due to the home not owning any scales. The manager stated that she had been unable to obtain suitable scales due the fact that the company had decided to use a new maintenance company and no one would accept responsibility for purchasing the scales. This situation needs to be urgently resolved. It will remain a requirement that both of these issues are addressed. Action must be completed by 28th February 2006. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21 Service users have clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Care plans are regularly updated to ensure both physical and emotional health needs are met. Changes are recorded and acted upon. Health needs are met and service users have full access to all professional health care services as required. EVIDENCE: Several residents were seen to have specialist communication equipment. Further discussion with the manager and staff confirmed that this equipment had improved the basic quality of life for the residents concerned. It had taken a long time to have any impact but staff had persevered and a good end result had been obtained. Due the communication difficulties with the residents it was difficult to obtain their opinions on how well the home was meeting their needs. Evidence was taken from discussion with staff and the homes records. With regard to illness and death the home had struggled to obtain relevant information from families but had handled the situation with respect and sensitivity. The home is advised to continue to attempt to find out the wishes 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 13 of the resident or their representative. The organisation does have a written policy on this subject but the home is advised to write one that is relevant just to Downer Court. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents are protected by a robust complaints system. Adult Protection Policy and procedures protect the residents from abuse. EVIDENCE: The home has adopted Kent and Medway’s procedure on Adult Abuse and all staff were trained in this subject. Discussion with staff confirmed they had a good knowledge of Adult Abuse. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents in the home have benefited from recent redecoration and some new furniture. Residents are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. Whilst residents’ rooms are homely and comfortable not all service users benefit from living in rooms that meet the requirements for space. The residents benefit from living in a clean, pleasant and hygienic home, however the laundry facilities are poor. EVIDENCE: The home had undergone a large programme of redecoration including all rooms except the kitchen. New settees, tables and chairs, a new television cabinet, coffee tables and an entertainments unit had been purchased and installed. There were plans for a new carpet in one of the lounge /diners after April 2006. All of this work had greatly improved the environment for the residents. As stated in the last report the building does not meet with the standards required for room sizes and staff facilities. The double rooms are far too small to be used for two service users to share and consideration must be given to 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 16 offering rooms as single accommodation as soon as possible. Two of the single rooms are also very small and could be utilised better as offices or either visitors or storage rooms. The broken shower cubicle highlighted in the last report had been removed and the area made good. The bedroom with the very damp ceiling had also been repaired and the ceiling made good. Laundry facilities were provided in the garage. There was no separate hand washing facilities, with only one sink that was used for domestic tasks. The floor was not impermeable and the wall finishes were not readily cleanable. The room had lots of cobwebs. There were no sluicing facilities. There were tiles missing from the roof. This needs to be addressed and a requirement will be made On the day of the inspection the homes was clean, hygienic and free from offensive odours. The roof on the porch between the two sides of the building was showing signs of leaking and this needs to be addressed. The door leading to the garden had been assessed by the organisations Health and Safety manager who advised that the door be lowered to ensure residents in wheelchairs can access the rear/side garden. This work had not been completed however the manager did state that the work was to be costed by the new maintenance company in the near future. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33,34,35,36 The residents benefit from being cared for by staff who have a good understanding of their needs though severe staff shortages have resulted in residents not always receiving consistent care or consistent levels of activities. EVIDENCE: At the last inspection it was highlighted that the home was seriously understaffed, although the report was written in July 2005, staff had only just been recruited but had not actually started. Some were still waiting for the necessary checks to be completed. When the new staff actually start the home will have 808 staffing hours which is still 20 hours short . The Service Coordinator agreed these hours could be filled. The manager is now involved with the recruitment process and she feels this helps her have the right staff for the home. The manager does have records of staff training but was advised to produce a training matrix so that she could monitor when mandatory training is required. All staff required Moving and Handling training as none had been offered within the last year. A requirement will be made 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 18 All of the current staff had completed NVQ 2. The new staff would be encouraged to complete their award. Approximately half of the staff were working towards their NVQ three awards. Discussion with the manager confirmed that last year the staff were not supervised at least six times, however plans were in place to ensure this would happen this year. The requirement made at the last inspection will remain until it can be evidenced that supervision is actually being carried out. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The residents benefit from having a manager who is supported well by senior staff in providing clear leadership throughout the home and by staff who demonstrate an awareness of their roles and responsibilities. EVIDENCE: The manager is registered with the Commission and is currently completing her Registered Manager Award. It was hoped that her award would be completed by October 2006. On the day of the inspection it was evident that she was competent and sufficiently experienced to run the home and meet its stated purpose, aims and objectives. It was also evident that the welfare of the current service users was very important to her. The manager was hoping that when the new staff start she will be able to spend more time with her management responsibilities. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 20 Staff confirmed that the manager was approachable and communicated a clear sense of direction and leadership. It was evident that the staff group worked well as a team. Regular staff meetings were held. As in all MCCH homes, quality assurance and quality monitoring was not happening. This was discussed and work had been started to address this issue. The home did not have an annual development plan or a business or financial plan in place. Again this was discussed and plans were in place to produce these documents in the coming year. With regards to the health safety and welfare of the residents and staff, the necessary checks and records were viewed. The main issue was around the hard wiring, as recommendations for remedial work to the system had been made but not acted upon. The Service Co-ordinator agreed to inform the commission about the outcome as soon as possible. Another area of concern was the water temperature in the home. It was consistently too cold for the residents to have a comfortable bath. One day the records showed it only reached 12 degrees centigrade. It would appear that the boiler is either insufficient or in need of replacement. It will be a requirement that a suitable boiler is fitted and maintained. 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 21 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 1 2 X 3 X 4 X 5 1 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 2 25 1 26 3 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 2 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X 2 3 3 1 X X 2 X 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 22 yes 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. 1 Standard YA1 Regulation 4and 5 Requirement The registered provider shall produce and make avaliable to the Commission a copy of the homes Statement of Purpose and a Service User Guide. A contract stating the terms and conditions shall also be provided. This is outstanding from the last inspection. The nutritional needs of the service users are to be assessed and appropriate methods of weighing service users are to be provided. This is outstanding from the last inspection. The Registered Person shall ensure that persons working at the care home are appropriately supervised. This is outstanding from the last inspection. Action plan required The Registered Person shall ensure that adequate laundry facilities are provided that met with Infection Control guidelines. Action plan required The Registered Person shall ensure that a suitable boiler is DS0000064406.V278003.R01.S.doc Timescale for action 28/02/06 2 YA17 13 28/02/06 3 YA36 18(2) 28/02/06 4 YA30 13(3) 28/02/06 5 YA42 23(2)(p) 28/02/06 1-2 Downer Court Version 5.1 Page 23 6 YA24 13(4)(a) 7 YA35 18 8 YA42 13(4)(a) provided that supplies adequate amounts of hot water to meet the needs of the residents. Action plan required. The Registered Person shall ensure that service users can access the rear/side gardens. Action plan required. The Registered Person shall ensure that all staff are trained in safe Moving and Handling. Action plan required. The Registered Person shall ensure that work highlighted in the electrical report is completed. Action plan required. 28/02/06 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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 1-2 Downer Court DS0000064406.V278003.R01.S.doc Version 5.1 Page 25 - 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. 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