Inspection on 20/07/07 for 1-2 Downer Court

This inspection was carried out on 20th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-2 Downer Court 02/08/06

1-2 Downer Court 18/01/06

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 Wilson Avenue Rochester Kent ME1 2SA Lead Inspector Chris Woolf Key Unannounced Inspection 20th July 2007 09:05 1-2 Downer Court DS0000064406.V345921.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 1-2 Downer Court DS0000064406.V345921.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. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1-2 Downer Court Address 1-2 Downer Court Wilson Avenue Rochester Kent ME1 2SA 01622 769100 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) t.mateer@mcch.org.uk MCCH Society Limited Vacant 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.V345921.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 02 August 2006 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. Service users with physical disabilities can be accommodated. 24-hour support is provided by a team of support staff led by an acting Manager. This service is part of the MCCH society. The current fees for the service range from £1330.45 to £1385.80 per week and are based on an assessment of individual need. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is t.mateer@mcch.org.uk. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information for this report is based on an unannounced visit to the home lasting 5 hours. The visit included meeting with all service users; talking with staff on duty and a visiting professional; a tour of the home; observation of day to day life in the home and the way in which staff and service users interact; and inspection of a variety of records. Although the manager was not on duty on the day of the site visit the Team Leader was very helpful in providing all of the required information and answering questions. What the service does well: What has improved since the last inspection? Two new boilers have been fitted, one either side of the home, and service users can now be sure of getting hot water when needed. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 6 The patio doors from both lounges have been supplied with ramps to enable wheelchair bound service users to access the garden area. One service users bedroom has been painted and decorated. New Television aerials have been fitted. The home has recently had a recruitment drive and new staff are due to start work in the home soon. 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. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 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.V345921.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, & 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective service users are given the information they need to make a decision about the home, their needs are fully assessed and they have a series of trial visits so that they know that the home can meet their needs EVIDENCE: MCCH have a comprehensive assessment programme for prospective service users. There are clear admission policies and procedures. There have been no new admissions to the home since the last inspection but it was noted on the report that the last service user had his needs fully assessed by the manager of his previous home and the manager of Downer Court. Prospective service users have a series of visits prior to admission. These start with 1 day visits over a 2 month period, then 2 day, 3 day, overnight, and a week. A diary is kept and there is a personal care planning facilitator liaises between the staff teams of Downer Court and the service users current home. Care Management assessments are also obtained for all service users. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 9 The current service users needs are being met at the home. Although 2 service users are sharing a rather small bedroom their privacy and dignity are being upheld by the staff and the home is currently considering ways of providing a moveable screen for the room for the odd times when it may be more difficult to maintain privacy. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 10 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, & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users have an individual plan that meets their needs; they are supported to make their own decisions and to take control of their lives; and they are supported in taking reasonable risks. EVIDENCE: Each service user has an individual plan of care that contains a holistic picture of their needs. Information in the care plans is very detailed and gives good instructions to the staff of how to care for each service user for all of their normal daily routines. Care plans are reviewed and amended monthly, and additionally when any changes or new information come to light. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 11 The home uses person centred planning to support service users to express and have recorded their hopes and dreams. They are assisted to make decisions about all aspects of their lives as far as their physical and mental capacity allows them. A staff member commented, “We show them objects to remind them what’s going to happen”. Larger decisions are supported through the use of person centred planning. Staff offer objects or pictures to help service users to make relevant choices and their preferred method of communication has been included in their individual care plan. Examples of choices offered are meals, activities, daily routines, privacy and clothes. A staff member said, “We take notice of their body language and know what they want”. Service users are supported in taking responsible risks. All potential risks are assessed, minimised, and documented. Risk assessments are all very comprehensive and easy to follow. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16, & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lead a lifestyle that meets their needs and wishes, their independence is supported, they are encouraged to maintain relationships. and they receive a balanced diet. EVIDENCE: None of the existing service users choose to take up paid or voluntary employment. Their interests are identified in their individual care plan and they are encouraged to attend the Mencap day centre or Prospects. Service users are supported to take part in events in the local community and often visit the local pub, market or go to church. Staff said, “we take them 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 13 shopping, swimming, bowling, cinema and pub lunch” and “we go on holidays with them”. Each service user has their own bank account and the staff assist them in accessing this. There is a good variety of leisure activities available each week and service users can choose whether they wish to join in or not. Activities include a visiting Aroma therapist, an activities co-ordinator twice a week, sensory room, board activities, and visits to the hydro-pool. The home has a personal relationships and sexuality policy. Family and friends are welcomed into the home. Staff support the service users to maintaining relationships both within the home and in the community. The daily routines of the home promote independence and individual choice. For example service users have their own choice of where they want to spend their time, what time they want to get up and if they want to go back to bed. All service users have their own key although most rely on staff support to go out. They are able to help with meal preparation and clearing if they wish. Currently only one service user has any involvement, this involves occasional cleaning and washing up when she chooses. One service user has a tank with tropical fish and on the day of the inspection site visit staff and service users were excited at discovering that there were three baby fish in the tank. Service users can choose when they want to be alone and their privacy is respected. A staff member commented, “We respect their rights as long as it does not infringe on the rights of the other service users”. Choices of menu are offered to service users on a daily basis. There is a set daily menu but this is not rigidly adhered to and other choices are always available when wanted. Once a week service users have a choice of takeaway meal. The home is currently working on producing nutritional assessments for all service users. All food choices are recorded in each individual’s plan of care. The home has recently obtained the Safer Food Better Business system for checking on food hygiene. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 14 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, & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users’ personal and health care needs are met by the home supported by a multi-disciplinary health care team. EVIDENCE: Service users personal needs and preferences are included in their plan of care. Staff employed at the home has a good understanding of the service users needs and are trained and competent to meet these needs. Staff ensure that service users privacy is maintained whilst personal care tasks are being undertaken. One staff member commented “We close doors whilst we do personal care, and make sure we keep them covered up”. The staff of the home, supported by a multi-disciplinary health care team, meets the health care needs of the service users. Evidence was seen of the 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 15 involvement of Doctors, nurses, chiropodist, dentist, physiotherapy, psychiatrist, speech and language therapist and optician. All appointments with health professionals are recorded in the individual service users plan of care. A staff member commented, “The care is good”. The home has sound medication policies and procedures. Recording is sufficient to allow for an audit trail. Protocols are in place for the correct administration of ‘as required’ medication. The MAR book is properly completed and contains a signature sheet and photographs of the service users. Medication is audited 3 times a day. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 16 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 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users know they can complain and that any concerns they have will be taken seriously; and that they will be protected from abuse. EVIDENCE: The home has a clear complaints procedure produced in pictorial form, and a copy is on display in the hallway for easy access. All complaints are investigated and outcomes are recorded. There have been no complaints recorded since the last inspection. Staff indicated their awareness of actions to take if a complaint were made to them. There has been no adult protection alerts raised on the home since the last inspection. There is a robust adult protection policy in place. Although staff received basic training in adult protection during their induction and NVQ training the home is intending to arrange for all staff to receive additional formal adult protection training. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 17 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, 26, 27, 28, & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a homely environment, although their own rooms are small. Service users safety may be put at risk through inadequate infection control measures in the laundry area. EVIDENCE: The home is made up of two bungalows that have been linked and made into one. Service users are able to transfer easily between the two parts giving them the choice of where they spend their time. The home is safe, comfortable, bright and free from offensive odours. Furnishings and fittings are domestic in character. The location of the home is close to local shops and transport systems. A staff member commented, “It’s a nice relaxed house”. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 18 Since the last inspection ramps have been provided at the patio doors, making the garden accessible from both lounges. The garden is attractive and provides a pleasant place for service users to sit to enjoy the sunshine and fresh air. Although most of the bedrooms are small and do not meet the national minimum standards this is reflected in the statement of purpose. All bedrooms have all been decorated and personalised to meet the needs of the individual service users. There is one double room and the home is currently trying to access appropriate screening to use when necessary to ensure privacy. The home is also seeking ways of reviewing the situation to provide all single rooms. When one of the existing service users moves out of the shared room it must only be used for single occupancy. On the last report there was a requirement regarding the hot water for the bathrooms. Since that time 2 new boilers have been installed and hot water is no longer a problem. There is one bathroom, one shower room, and a separate toilet and service users from either side of the house can use the bath/shower room of their choice. The shared space consists of a lounge/dining area and a kitchen each side of the home with a link/vestibule where one service user enjoys sitting. The home is clean and free from offensive odours. Infection control procedures are in place. However infection control procedures are compromised by the fact that the floor of the laundry area is concrete and does not have an impermeable and washable covering. A requirement was made regarding this at the last inspection. This has not been actioned and has therefore been repeated on this report. The management must now address this issue without further delay. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. An effective, competent and qualified staff team supports Service users. EVIDENCE: Currently 85 of the care staff are trained to NVQ 2 or above and a further 2 staff are working towards this qualification. 5 of the carers also hold Level 3 and 1 has Level 4 and more staff are working towards these higher qualifications. A staff member said, “I am doing my Level 3 now”. The company’s recruitment procedures are sound. No new member of staff is employed until a Criminal Records Bureau enhanced disclosure and 2 satisfactory references have been received. A Provider Relationship Manager from CSCI assesses the recruitment practices for all of the services owned by MCCH. All new staff undertake Induction Training to Skills for Care specifications. Statutory training is fairly well up to date but there are gaps in Adult Protection 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 20 and Infection Control and a recommendation has been made that all staff are updated in these subjects. The home is currently arranging for SKIP (intervention without restraint) training. Evidence was seen of attendance at a variety of other training courses. There was a recommendation on the last report that staff should receive formal supervision at least 6 times a year and this is now being done. One staff member made the general comment, “The staff are all nice”. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 21 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, & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the service users and the health, safety and welfare of service users and staff is protected. EVIDENCE: The manager of the home has recently changed and although the new manager has the relevant qualifications she not yet gone through the process of becoming the Registered Manager. Staff spoke highly of the new manager 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 22 and all staff spoken to agreed that the manager gives support to both service users and staff. The home monitors the quality of their service, although formal quality questionnaires are not currently used to gather the views of the service users and other interested parties. Families are sent questionnaires prior to individual Personal Plan Reviews and their views are documented at that time. The home benefits from regular documented visits from the responsible individual. They carry out regular audits of a variety of systems and procedures. The home would benefit from having a formal quality assurance policy. The health, safety and welfare of service users and staff are protected. Comprehensive risk assessments have been completed including environmental risks. Accident records are regularly monitored. Staff training in health and safety related subjects is up to date and relevant with the exception of infection control and this is currently being arranged. All safety certificates viewed were up to date and the date for a fire risk assessment is booked. 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 3 4 3 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 2 26 3 27 3 28 3 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 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 3 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 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES 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 YA30 Regulation 13(3) Requirement The laundry floor must be impermeable and easy to clean, to meet with Infection Control guidelines. (Outstanding requirement timescale of 01/09/06 not met). Timescale for action 31/10/07 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. Refer to Standard YA35 Good Practice Recommendations All staff should be up to date with Infection Control and formal Adult Protection training 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local 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 1-2 Downer Court DS0000064406.V345921.R01.S.doc Version 5.2 Page 26 - 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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