Inspection on 19/07/05 for 12 Downview

This inspection was carried out on 19th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

12 Downview 02/10/08

12 Downview 04/10/06

12 Downview 05/12/05

12 Downview 01/03/05

12 Downview 01/03/05

12 Downview 01/03/05

12 Downview 01/03/05

12 Downview 25/08/04

12 Downview 25/08/04

12 Downview 25/08/04

12 Downview 25/08/04

12 Downview 02/03/04

12 Downview 02/03/04

12 Downview 02/03/04

12 Downview 02/03/04

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Treloar College

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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 12 DOWNVIEW The Cottage Hungerford Berkshire RG17 0ED Lead Inspector Tracy McGuire-Brown Unannounced 19 July 2005 @ 10:15 th 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. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 12 Downview Address The Cottage Hungerford Berkshire RG17 0ED 01488 683087 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) Mr T N Shoesmith Care Home 7 Category(ies) of Learning Disability LD registration, with number of places 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: People with a learning disability aged 18 to 65 years Date of last inspection 01/03/05 Brief Description of the Service: 12, Downview and The Cottage provide accommodation for up to 7 Service users of either sex, aged between 18 and 65, who have a learning disability.The Home is situated Hungerford within easy reach of all local amenities.The Objective of the home is offer encouragement, instruction and stimulation whilst encouraging independence.The home offers a mix of single or double rooms for Service Users and there is a Cottage offering additional accommodation within the grounds. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection, which took place over a 3 and a half hour period. The Inspector briefly spoke with some of the residents and staff that were preparing to leave for a day trip out. The Inspector spent most of the inspection with the newly appointed Manager. The Inspector was shown around the home and also examined some records. What the service does well: What has improved since the last inspection? What they could do better: 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 6 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. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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 The home gains assessment information prior to admission and continues to update this information. EVIDENCE: A sample of records was examined, there have been no new Service Users admitted to the home since the previous inspection. The admission policy has not changed and is satisfactory. The Manager has begun developing new care records and these were examined by the Inspector: these records include historical and assessment information. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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) 6,7and 9 Service Users all have individual care plans; these vary in content and detail. Service Users are consulted and supported to make some decisions. Service Users have individual risk assessments in place. EVIDENCE: Service Users all have individual care plans in place, the Manager informed the Inspector that generally there as been little change to the car plans since the previous inspection The Manager has begun developing new styles of care plans which are more detailed. The Inspector examined the sample care plan called an Essential Lifestyle Plan, which has been developed and is of an excellent standard. The Manager discussed the plan to ensure all Service Users have the same style of Lifestyle Plan developed. The new style Essential Lifestyle Plan will involve Service Users in the development of this record. The development of care plans needs to continue. Records such as daily progress sheets, “my choice” and Service User meeting minutes document when Service Users make decisions. The Manager informed the Inspector of plans to develop Service Users decision-making skills further. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 10 Each Service User has individual risk assessments in place. The Manager showed the Inspector work in progress to review and develop the risk assessments further. The work developing risk assessments needs to continue. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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 standard(s) 12,13,15,and 17. Service Service Service Service Users Users Users Users have a range of appropriate educational and work activities. all utilise and participate in the local community. are supported to maintain and develop appropriate relationships. have a choice of varied and well-balanced meals. EVIDENCE: Service Users continue to be supported by the home to undertake a variety of day care activities; these include work and educational opportunities. On the day of inspection a group of Service Users were going on a train and then for a walk and picnic another Service User was out at work. The Manager is in the process of developing more detailed individual day activities programmes; a sample of a new programme was seen. Day care programmes seen indicate that the staff continue to provide excellent and varied day care including: work opportunities and a trout farm and Littlecote House, attendance at college, regular hikes and walks, art, craft photography, church, library, gym and aqua aerobics. The Manager showed the Inspector the new day care files which have been developed also, these are of good standard and include photographs of 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 12 Service Users undertaking activities, any reports and information relating to day activities and a day programme. The Service Users utilise the local community in a variety of ways, including attendance at the local G.P’s., visits to the local shops libraries, pubs and restaurants. Service User care plans, activity sheets and progress sheets detail Service User involvement in the community. Daily progress sheets and individual Service User files indicate that service users are supported to maintain and develop relationships with family and friends. Guidelines are in place if required. The home has a menu, which is varied, and choice is available. Service Users are supported to prepare meals and the choice is made on the day from the food stocks available. Records of food consumed are kept but there were some gaps in recording and this recording needs to be consistent, this was a requirement at the previous inspection. The Manager discussed with the Inspector work in progress to support the Cottage Service Users to develop their culinary skills further. Records of menus seen indicate the Service Users have a varied and balanced diet. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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 standard(s) 18 and 19. The physical and emotional well being of service users is considered and met. EVIDENCE: Each Service Users has specific file detailing medical and healthcare appointments and assessments. All healthcare appointments are recorded. Service users wishes in respect of support for personal and emotional care is supported by care plans. The staff seek support from other professionals if required e.g. a discussion was held in respect of the involvement of the GP and psychologist to support a Service User with a specific issue. The Manager showed the Inspector an example of the newly developed Essential Lifestyle Plan, which includes sections relating to health and personal care, details of medication and “what people need to know to support me” These plans need to be developed for all Service Users and the Manager intends to work with the staff to complete this. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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 standard(s) 22 The home has a satisfactory complaints procedure. EVIDENCE: The home has a satisfactory complaints policy in place. There is a complaints log and the last recorded complaint was dealt with in a satisfactory manner and within a satisfactory timescale. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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 standard(s) 24 and 30 The premises are homely, well maintained, safe and comfortable. The home was clean and tidy throughout. EVIDENCE: The Inspector viewed the premises. The home is well furnished and nicely decorated throughout. The Manager informed the Inspector that the Proprietors are about to purchase some new sofas for the lounge. The home is currently well furnished and equipped. The dining room chairs are in need of some maintenance or replacement. The premises have a cellar, which is only used by staff and is for storage purposes only, it would be beneficial to review the use of the cellar and consider any safety issues. There is a large garden to the rear of the property, which is secluded and well maintained. The home has a separate laundry room, which is a good size. The home was very clean and tidy throughout. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 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) EVIDENCE: These standards not inspected on this occasion. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 17 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) EVIDENCE: These standards not inspected on this occasion. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 x 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 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 3 x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 12 DOWNVIEW Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 19 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 17 Regulation 17(2) Requirement Menus need to be detailed and all foods consumed recorded. Timescale for action 31/08/05 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 6 24 Good Practice Recommendations Continue to develop essentail lifestyle plans for all Service Users. Review use of cellar and consider any safety issues. 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA 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 12 DOWNVIEW H52-H01 S11202 12 Downview V235297 020805 Stage 4.doc Version 1.40 Page 21 - 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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