Inspection on 24/07/06 for 10 Exmoor Crescent

This inspection was carried out on 24th July 2006.

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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

10 Exmoor Crescent 02/10/07

10 Exmoor Crescent 12/01/06

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Southfields

Thorndene

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33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 10 Exmoor Crescent Durrington Worthing West Sussex BN13 2PL Lead Inspector Mrs S Rodgers Key Unannounced Inspection 24th July 2006 12:30 10 Exmoor Crescent DS0000064725.V297687.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 10 Exmoor Crescent DS0000064725.V297687.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. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10 Exmoor Crescent Address Durrington Worthing West Sussex BN13 2PL 01903 693050 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) Outreach 3 Way Mr Michael Paine Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to three (3) service users aged from 18-65 years in the category of Learning Disability may be admitted/accommodated. 12th January 2006 Date of last inspection Brief Description of the Service: 10 Exmore Crescent is a care home registered to provide accommodation for up to three adults with a learning disability. The property is a detached 3 bedded bungalow situated in a residential area of Durrington. The garden is to the side of the property with an enclosed paved area to the rear. The establishment is close to some local shops and is approximately five miles from Worthing town centre. Outreach 3 Way owns the services. The current weekly fees are £1690; extras include hairdressing, personal toiletries, and reflexology and leisure activities. The report is made available to interested parties on request. The registered manager responsible for the day-to-day running of the home is Mr Michael Paine. The responsible individual on behalf of the providers is Mrs Vanessa Keen. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3 hours. This inspection was undertaken by the lead inspector and Mrs Judith Farrell who is also a Regulatory Inspector. Planning for this inspection was based on reviewing the pre inspection questionnaire, the most recent inspection report, records such as the Statement of Purpose, Service User Guide and general correspondence. During the course of the inspection the inspector toured the home and reviewed records. Due to the profound needs of the residents communication is difficult for people who do not have regular contact with them, therefore the inspectors took the time to observe residents interact with staff. The inspector was able to ascertain that the interactions between staff and residents were relaxed and confident. The inspector observed that staff are able to communicate well with residents and staff understood each residents method of communication i.e. a special sound or look. All residents were seen at the inspection. Residents have their own planned activities. Residents are taken the day centre, shopping or any other planned activity at various times of the day depending on their individual timetable. Four staff were on duty at the time of this visit. The manager and his deputy and two care workers. One staff member was spoken with formally throughout the inspection and one other on an informal basis fitted around caring for the residents. Where standards have not changed from the previous inspections this report records that the findings were the same. Two requirements have been identified at this visit. An action plan advising the Commission of action to be taken and timescale in which compliance will be met should be submitted by 7 September 2006. What the service does well: Residents continue to be supported to develop and maintain an active lifestyle within their assessed capabilities. Residents are also offered the opportunity to attend day centres and access local amenities within the community. The care planning records are of a good quality and assist staff with understanding how to deliver the appropriate care to each resident. Staff treat all residents as individuals and planned activities are based on residents preferences. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. 10 Exmoor Crescent DS0000064725.V297687.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 10 Exmoor Crescent DS0000064725.V297687.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose, Service User Guide and the admission process enables prospective residents and their representatives to make an informed decision as to whether the service can meet the needs of the individual. EVIDENCE: The homes Statement of Purpose and Service User Guide clearly advises prospective resident, relatives and placing social workers of the services provided. Both documents are in written text and symbol format and are displayed in the hallway of the home. The have been no new admission since the last visit. At that visit pre admission documentation demonstrated that residents admitted to the home underwent a pre admission assessment to ensure that the service would be able to meet the individual and collective needs of the residents. Pre admission assessments are carried out as per the organisations admission policy and procedure. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 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): 6,7,9 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents assessed needs and personal goals are reflected in care plans. Residents are encouraged to make decisions about their lives with assistance. Risk assessments are undertaken to enable residents undertake various activities. EVIDENCE: All three care plans were seen at this inspection. Care plans are detailed contain clear information on what care is required and how care should be delivered. However it was noted that the care plans have not been reviewed in the year that residents have been residing at the home. Mr Paine confirmed that he is aware that all care plans should be reviewed six monthly however due to limited number of supernumerary management hours there has not been time to undertake and record formal reviews. See standard 37. Residents have a ‘communications book’. The book contains a summary of needs and details guidelines on how to deliver care including triggers that may 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 10 cause distress to residents and what action to take should the individual become distressed. There are also plans to formulate a booklet containing relevant information should residents be taken to hospital. Activity sheets evidence that residents are asked what they would like to do. For example activity programmes reflect daily activities however residents are still asked if they want to undertake that activity or not. Residents will have the opportunity to be present at reviews in order that they can have a choice regarding services provided. There response to new and old activities or situations or suggestions will be observed and services adapted accordingly. Systems are in place to hold money in safe keeping for residents; records seen were in good order. Two resident have their own bank or building society account. The finances of one resident is maintained and held at the head office, the inspector was advised that the individuals money was held in the organisations main bank account and accessed as required upon request of Mr Paine and/or his deputy so that his personal allowance money held in the home is topped up. The organisation must make arrangements to separate the individual’s money from their main account because the organisation acts as a trustee in respect the resident’s money. And as such owes all the duties of a trustee to this resident in this respect. The current residents have high dependency needs and depend on staff to assist them with every day activities however should a new activity be undertaken risk assessments are carried out and action is taken to minimize risks and hazards. If a risk is identified it is crossed reference with assessed needs of all aspects of daily living. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16,17 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered and take part in appropriate leisure activities and access the local community. Residents are supported to maintain appropriate relationships. The rights of residents are respected. Residents are offered a varied diet. EVIDENCE: Each resident has a programme of activities appropriate to their needs and wishes. Programmes indicate that residents attend day centres and colleges, go to local shops and access other leisure activities within the community such as bowling and swimming. The service has purchased an unobtrusive people carrier to transport residents to and from activities and appointments. Care records indicate key family and personal relationships. In principle residents can also invite friends to the home because of the profound disabilities it is not a usual practice as disruption to daily routines can cause residents to become anxious. Staff are aware of residents rights to privacy. Staff were observed to knock on bedroom doors prior to entering their rooms. Residents mail is opened with 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 12 residents present, and staff talk with residents and not just amongst themselves when residents are present. Menu’s seen at this inspection evidence that a varied diet is offered. Fresh fruit is readily available. Special dietary needs are addressed. During this visit the inspectors witnessed a good example providing residents with choice. One resident was having lunch; the staff member assisting gave a choice of pudding by showing the resident what was on offer. The resident choose fruit from the fruit bowl, because the resident could not point directly to the type of fruit she wanted the staff member pointed to each piece of fruit and watched for a reaction to confirm what the resident wanted. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 13 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): 18,19.20 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every effort is undertaken to ensure that residents receive support in the ways they prefer. Residents physical and emotional health needs are met. Appropriate systems are in place for dealing with medicines. EVIDENCE: Care plans have information regarding individual’s personal likes/dislikes. The plans also provide some evidence to indicate how and when residents want their care to be provided. Due to the profound needs of residents it is difficult to determine whether the support given is in a manner they prefer however, staff confirmed that they take care to note the resident’s reactions to situations and then plan how to provide care accordingly. Records clearly demonstrate that residents are registered with a local doctor and that they have access to other health professionals such as dentists, chiropodists and opticians. The home has a pharmacy agreement with a local chemist. All staff that administer medication have received training in the administration of 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 14 medication. Records seen of the receipt, recording, storage, handling, administration and disposal of medication were in good order. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 15 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): 22,23 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place. Systems are in place to protect residents form abuse, neglect and self–harm. EVIDENCE: The homes complaints procedure clearly advises residents and/or their relatives of their right to complain. The procedure states each stage of the complaint process and timescales in which the complaint will be dealt. The complaints book was available. Since the last inspection all staff have received training in Adult Protection procedures. Staff spoken with at this inspection gave a good account of action they would take should they suspect abuse of a resident. They were also able to demonstrate that they are aware of the different types of abuse. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 16 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): 24, 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accommodation is appropriate to the needs of the residents. The home is clean and hygienic. EVIDENCE: From touring the home both inside and out the inspectors were able to ascertain that the home appears to be well maintained. The home has recently undergone refurbishment. Ramps have been provided at the front and back entrances to ensure easy access via wheelchairs. The home is bright, airy and comfortable. Appropriate systems are in place for the collection of clinical waste. Laundry facilities are separate from the food preparation areas and appear suitable for the needs of the current residents. Appropriate protective clothing and hand washing facilities are provided. The home has a contract with a clinical waste disposal firm. The management of the disposal of clinical waste was seen to be in good order i.e. there were appropriate bins both inside the home and 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 17 outside and the appropriate sacks and containers were used in which to place clinical waste. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 18 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, 34, 35 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were relaxed, confident and knowledgeable with regards the needs of residents. Recruitment procedures are in place. The staff-training programme needs to be developed. EVIDENCE: Duty rotas indicate that staff are on duty in sufficient numbers and with the appropriate skill mix i.e. inexperienced staff are not on duty together without the support of experienced staff. The staffing structure of the home means that management hours are mainly care hours. This does not compromise the care but does have the potential and has compromised essential management duties such as reviewing and updating care records. All new staff receive induction training. Staff are encouraged and supported to undertake National Vocational Qualification Awards specific the needs of the current residents, (Learning Disability Award Framework). Out of the nine staff working at the home 4 have completed a National Vocational Qualification level 2 or above and one other is currently enrolled on the course. 40 of care staff hold a National Vocational Qualification. Although 50 ratio of all staff hold this qualification is not met a requirement has not been made as the service is working towards meeting this target. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 19 A recruitment process is in place. Records seen were in good order. The organisation has requested that all staff records be stored at their head office. This has been agreed and in future staff records will be reviewed at the head office of the organisation prior to a visit to the home. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 20 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): 37,39,41,42 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and is running the home in line with its aims and objectives. The views of residents and other stakeholders are sought. Records required by regulations must be kept under review and up to date. Systems are in place to maintain the health and safety of residents. EVIDENCE: Mr Paine has gained the National Vocational Qualification Level 4 and the Registered Managers Award. Staff spoken with confirmed that Mr Paine is approachable and receptive to others opinions. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 21 Records seen on the day of this inspection indicate that a quality assurance and monitoring system has been undertaken. The information gained from resident, relatives and other stakeholders has been collated and the findings from the internal audit have been collated. A report has been produced. The manager and deputy manager were on duty to update paperwork, however due to the residents daily programmes, care staff were transporting residents to their activities and Mr Paine and his deputy were caring for the resident/s remaining at the home. The manager and his deputy have 7 hours each delegated to undertake office tasks however, due to the working arrangements of the home these hours are not always available which has resulted in reviews of residents care plans not being undertaken at six monthly intervals as stated in the National Minimum Standards. The home is generally well run with the needs of residents coming first, however the number of dedicated management hours to carry out reviews and update paperwork should be reviewed as residents changing needs may be compromised. Risk assessments are carried out and training is provided for ensuring safe working practices such as manual handling, fire safety, first aid, food hygiene and infection control are in place and understood. Maintenance records indicate that annual servicing of boilers, gas supply, water temperatures, and security of premises are undertaken. Records of accidents/incidents are maintained and were available. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 22 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 2 2 X 4 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 2 3 X 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 23 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. 1. 2. Standard YA6 YA7 Regulation 15 20 (2) (b) Requirement Care plans must be reviewed at regular intervals. The registered person shall not pay money belonging to any service user in to a bank unless the account is in the name of the service user, or any of the service users, to which money belongs, and the account is not used by the registered person in connection with carrying on or management of the care home. Timescale for action 07/09/06 07/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA41 Good Practice Recommendations Dedicated management hours should be reviewed in order that records required by regulations are reviewed and kept up to date. 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 10 Exmoor Crescent DS0000064725.V297687.R01.S.doc Version 5.2 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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