CARE HOME ADULTS 18-65 1 Johnson Close Battle Road St Leonards-on-Sea East Sussex TN37 7BG
Lead Inspector Jeanette Denereaz Unannounced 5 April 2005 16:00 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 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 Stationary 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 Johnson Close Version 1.10 Page 3 SERVICE INFORMATION
Name of service 1 Johnson Close Address Battle Road St Leonards-on-Sea East Sussex TN37 7BG 01424 853339 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) East View Housing Management Ltd Sandie Ann Cox-Standen Care Home 4 Category(ies) of Learning disability (LD) 4 registration, with number of places 1 Johnson Close Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated with be (four) 2. The people accommodated will be aged over eighteen (18) and under sixtyfive (65) years on admission Date of last inspection 30 November 2004 Brief Description of the Service: 1 Johnson Close is a 4-bedroom detached house situated in a quiet residential Close. The home is registered for 4 younger adults with learning disabilities, and at present all residents are female in their forties. The home is a spacious residence, offering a large lounge, a further commual room and a large kitchen dining room. The office is in a spearate room by the front door. There is a separate utility room with domestic style washing machine and tumble dryer. All residents have their own bedrooms. The house has a good front and back garden. There are no immediate local amenities within walking distance, however, Johnson Close is situated off the main Batlle Road that has bus routes to the locals towns of Battle and Hastings. The home is part of East View Housing Management Limited (EVH). 1 Johnson Close Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The service users requested that they be referred to as residents within this report. The inspection lasted from 16.00 until 19.30. Time was spent meeting the manager, inspecting a number of records, policies, procedures and other documentation. All resident were spoken to and they showed the inspector around the home including their bedrooms. The findings are that this was a good inspection and the interviews with the manager, residents and staff member on duty were positive and informative. It was clear that the manager Ms Cox-Standen has a good understanding of the care needs of all the current residents. It was evident that she has a management style, which is open and approachable. What the service does well: What has improved since the last inspection?
The home has continued to work hard at meeting the requirements from the last inspection. All residents now have their own Building Society Bank accounts. The manager and the staff continue to support residents, reviewing their wishes and aspirations. At the last inspection the manager had secure staff hours to enable residents to stay at home and pursue other community activities, because she felt the day services offered were not stimulating for
1 Johnson Close Version 1.10 Page 6 residents. However, the current residents decided they enjoy the day services offered by EVH and other local organisation including attending college. Therefore, these wishes have been facilitated by the home. The residents’ decisions were based on what they enjoyed, the camaraderie and routines of the current day services. The Manager informed the Inspector that the day activities of all the residents would be continuously reviewed by the key workers. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 1 Johnson Close Version 1.10 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 Standards Statutory Requirements Identified During the Inspection 1 Johnson Close Version 1.10 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 standard(s) 2, 3 & 4 A new resident has just recently taken up residence at 1 Johnson Close, she came to the home with health issues, which the home is addressing. It is early days yet, monitoring of this placement is undertaken, and review meetings planned to discuss the suitability of the home in meeting all the needs of the resident. EVIDENCE: The new resident before moving in, visited the home and the Manager undertook a comprehensive pre-assessment of her needs, including health issues. The manager has kept all agencies including the Community Learning Disability Team (CLDT) and the CSCI of incidents and actions taken with this resident and has had discussions with the said agencies to whether the home can in the long term meet her social and health care needs. 1 Johnson Close Version 1.10 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 standard(s) 6, 7 & 9 The residents’ care plans were very detailed and clearly assessed the changing needs and personal goals. All residents’ Individual plans of care were inspected and were found to be sufficiently detailed, up to date, and contained clear information to support staff to meet the needs of residents. The residents are consulted and participate in all aspects of the home, and decision making for residents is very important. EVIDENCE: The plans were found to be user-friendly and the staff are instructed by the manager on how to complete the documents. All residents have detailed risk assessment in place, and there is evidence that risk management is reviewed regularly and outcomes recorded in individual care plans. The newest resident to the home is more independent, and wishes to go out alone and use public transport. The details of the risk management and strategies have been agreed with the resident. She has use of a mobile telephone when she visits her man friend at her last placement, so when she travelling on public transport she can be contacted and likewise she can contact the staff for assistance and advice. The residents’ days are full of activities and their care plans details that at weekends and evening they relax, attend clubs, go shopping, visit pubs and restaurants. Throughout the inspection the residents expressed pride in their home.
1 Johnson Close Version 1.10 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 standard(s) 12,13,15,16 & 17 The residents are totally involved in the running of the home, which include a cleaning and cooking rota, which is undertaken with total staff support. They all tidy their own bedrooms. All the homes records are user friendly and all the files seen by the Inspector were comprehensive, filed orderly and where appropriate reviewed. EVIDENCE: Three residents were totally involved in the evening activities of returning home, unpacking lunch boxes, and preparing the evening meal. It was evident from talking to residents that they go out on many trips and if they have an interest this is facilitated. They had recently been to see a live group in Hastings. Three service users fully take part in all social and community activities, they enjoy going on holidays and outings. The staff member interviewed said that she is always looking for interesting activities in the community, and will bring in details to discuss with the residents. The individual care plans detailed many activities which had been undertaken. The home is busy and the residents tend to occupy themselves with hobbies such as tabletop activities usually in the kitchen/dining or small lounge area.
1 Johnson Close Version 1.10 Page 11 They enjoy conversations with staff, and it was observed that the watching of television is not a popular pastime. However, the new resident does enjoy the television especially the ‘soap operas’. The manager has concerns that the new resident has not settled because her expectation of home life is not conducive to the home’s statement of purpose. She is reluctant to join in and take part in home life. The manager suspects she feels superior and is only just tolerating the other residents. The manager and staff are constantly observing this situation and will be discuss at the review of placement meeting. During the Inspection the menus were seen and the refrigerator and freezer was inspected and found to clean and full of healthy foods. There was fresh fruit and vegetables available and the menus contained ample of both. The Inspector saw the evening meal being prepared, the basic menu was followed, but the residents have a choice and the menus are altered and this information was recorded. 1 Johnson Close Version 1.10 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 standard(s) 19 & 20 The residents’ needs are sensitively met, and during this inspection the residents were supported to take their baths and showers, another was supported with medication and all general health needs were met in an adult and dignified manner. The home is fully aware of all the health needs of the residents, which are recorded appropriately in the individual care plans. EVIDENCE: Records seen during the inspection evidenced that all residents are registered with local GPs and Dentist. They all attend regular health check and other professional bodies are consulted when necessary including the CDLT The home has provided substantial support to the new resident with her health problems, which has included many hospital visit to seek specialist services. Also from the records no resident has been taken to Accident & Emergency Department since the last inspection. The residents said they were happy living at 1 Johnson Close and with the support they received from all the staff. 1 Johnson Close Version 1.10 Page 13 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 standard(s) 22 & 23 The home has good information on adult protection and all staff undertake training in this area during their induction. The Inspector asked the staff member on duty if she understood the organisation’s policy and procedures on protecting residents from abuse and the term whistle blowing. She gave a clear and comprehensive answer, which indicated the understanding of this area within the home. EVIDENCE: EVH has a policy and procedures on safeguarded residents from all forms of abuse, which also includes a ‘whistle blowing’ policy. The home has a comprehensive complaint policy and complaints book reported no entries since the last inspection Since the last inspection all residents now have their own Bank/Building Society accounts in which benefits are paid into, and residents are supported to access their own money. All financial transaction are recorded and receipts acquired, these records were seen by the Inspector and found to accurate. 1 Johnson Close Version 1.10 Page 14 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 standard(s) 24,25,26 & 30 The home is very comfortable, homely and well maintained. There are four single bedrooms and all are decorated and furnished to a high standard. There are adequate toilet and bathroom facilities, with one bedroom with an en-suite shower and toilet, family size bathroom and a separate toilet on the ground floor. The Inspector toured the home and viewed all the bedrooms, bathrooms and communal areas, and found the fixtures and fittings were found to be of a high standard, modern and in keeping with the environment. EVIDENCE: The home has an attractive back garden and surrounding side gardens in which the staff and residents undertake the gardening. The staff and residents are responsible for the cleanliness of the home and it is usually of a high standard. The home is generally clean and hygienic, however there was an unpleasant odour on the top landing. Also the curtain in the bathroom had been pulled down from the track. It seemingly had just been done during the evening. However, the Inspector was informed that this would be reported immediately to the maintenance person and would be repaired as soon as possible. 1 Johnson Close Version 1.10 Page 15 The home now has an incontinence issue, and now must dispose soiled waste in an appropriate matter. Consideration must be made to invest in a washing machine with sluice programme. Also risk assessments must be carried out on the removal and washing of soiled garments. Soiled washing must not be carried through an area of the home where food is prepared. 1 Johnson Close Version 1.10 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 & 36 The staff member on duty has been with the home for six months, she was very positive about the induction and on going training she has received. All the residents were spoken to individually and were very complimentary about the staff team at 1 Johnson Close, they said the staff were helpful and kind. EVIDENCE: The EVH organisation have a comprehensive induction and foundation training which includes the Learning Disability Framework Award (Ldfa) accreditation, with the progression onto NVQ qualifications. The induction training incorporates the organisation’s policies and procedures. The manager and staff receive regular supervision from line-management, and the manager holds regular team and house meetings A selection of staff records were seen, and found to be in order, as were all the supervision records. The supervision records were details, typed up and signed by the supervisor and the supervisee. Since the last inspection a sleeping staff member has replaced waking night staff. This has been implemented because senior management have reassessed the needs of the residents now living in the home. The manager however, has concerns with a resident that get up during the night, also the sleeping staff have usually been on duty that evening and she has concerns for their alertness to attend emergencies that may occur. Through discussion with
1 Johnson Close Version 1.10 Page 17 the manager there is a need for a re-assessment of the sleeping/waking night staff in the home, which details the residents needs during the night and the alertness of the staff. 1 Johnson Close Version 1.10 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38,39 &42 The manager is well motivated and competent ensuring the home is run well in the best interest of the residents. She is well respected by the residents and staff and it is evident that she has a management style that is open and approachable. EVIDENCE: Quality assurance systems based on seeking views of residents and other interested parties is undertaken by the EVH organisation. The method used is called SWOT (Strength Weakness Opportunities and Threats). This tool is undertaken annually in which views are obtained from residents, families, staff and managers. The feedback is give and the information is built into the organisational business plan. On a more in-house level the residents are encouraged to express their views and make suggestions. During the Inspection three of the residents were in the kitchen and were compiling a ‘wish list’ of things they wanted to do, see or buy. The manager and the staff member on duty took this very seriously. 1 Johnson Close Version 1.10 Page 19 All the Health and Safety documentation held in the home was seen, and found to be in order. Following the last Inspection it was recommended that the doors within the home been assess for their fire resistance, they were found not to met the required standard. The new doors have been ordered, but not yet in place. 1 Johnson Close Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score 3 x 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 2 x 1 Johnson Close Version 1.10 Page 21 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. 2. Standard YA30.1 YA30.2 Regulation 13(3)16 (2)(j)(k) 13(3) 16(2)(e) (f) Requirement It is required that the home is free from offensive odours. It is required that the home has procedures in place to ensure that soiled articles and clothing are not carried through areas where food is stored, prepared, cooked or eaten, and do not intrude on service users. It is required that the home ensures it has an effective staff team, with sufficent numbers to support service users assessed needs at all times icluding during the night. Timescale for action 1/05/05 1/05/05 3. YA33.1 18(1)(a) 1/06/05 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. Refer to Standard YA30.6 YA42 Good Practice Recommendations It is recommended that the home have a washing machine with a sluicing facility. It is recommended that the fire doors be fitted a.s.a.p. 1 Johnson Close Version 1.10 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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