Inspection on 06/07/05 for 147 Cheriton Road

This inspection was carried out on 6th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

147 Cheriton Road 16/01/07

147 Cheriton Road 10/01/06

147 Cheriton Road 02/02/05

147 Cheriton Road 02/08/04

147 Cheriton Road 05/01/04

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

CARE HOME ADULTS 18-65 147 Cheriton Road 147 Cheriton Road Folkestone Kent CT19 5HE Lead Inspector Michele Etherton Unannounced 06/07/05 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. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 147 Cheriton Road Address 147 Cheriton Road, Folkestone, Kent CT19 5HE 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) 01303 850475 Home Farm Trust Mrs Nicola Anne Masters Registered Care Home 8 Category(ies) of Learning Disability registration, with number of places 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February, 2005 Brief Description of the Service: 147 Cheriton Road, is located on a busy main road running through a pleasant residential area of Folkestone. The Home is close to a mainline rail station and is on a public bus route, it is close to a range of leisure and educational facilities and is within walking distance of the main town shopping area. The Home is Registered for 8 adults with learning disabilities and offers a spacious and comfortable environment to those who wish to develop their daily living and independence skills, the ethos of the Home encourages empowerment of Service Users, assertiveness and maximisation of potential with a view to moving on to a shared flat etc with minimal staff support at a later stage. Current Service Users prefer to be referred to as `Tenants. The premises consist of a large semi detached period property still retaining some original features. The accommodation ranges over four floors with a basement providing space for a laundry facility and additional storage. The kitchen, dining room, and tenants lounge in addition to the staff office/sleep in room and wash facilities are located on the ground floor, with access to the rear garden via the dining area. Tenant bedrooms are located on the first and second floors, and are all single occupancy. Access to these floors is by stairs only, the Home is therefore, unsuitable for anyone with a mobility problem. The Home has been open for approximately 12 years. Tenants are supported by a manager and seven care staff, a sleep in staff member is also provided at all times. Outreach is provided by the home to former tenants. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit undertaken over a three hour period. A reduced number of key standards were assessed on this occasion, including some assessment of progress made towards implementing previous recommendations. On the day of the visit, all of the tenants were about to leave on a day trip accompanied by three staff. One staff member was remaining in the house. Tenants spoke of the trip and indicated this had been planned for some time, and that in some cases they had rescheduled usual activities in order to attend. All of the tenants were dressed appropriately for the changeable weather. The visit included a part tour of the premises. Only one bedroom could be viewed on this occasion as tenants had locked them before leaving the premises as is there usual practice, and this was respected. Communal spaces were assessed. The Home is clean, homely and maintained to a good standard, although some areas have become more noticeably worn and in need of upgrading and these have been highlighted as recommendations within the report, particularly a first floor bathroom, and the dining room carpet. The inspector met three staff briefly before the tenants left the premises and spoke with a further two in more depth during the course of the visit. A reduced range of documentation was reviewed on this occasion, and whilst generally this was found to be in good order, accessible and well maintained, the inspection highlighted one requirement in respect of the Care plans in use by the home, a recommendation in respect of improved recording of tenants individual food intake, the need for sample signatures of staff administering medication, and a tenant risk assessment around part self administration were made. In addition, it was also recommended that a central index of complaints be maintained for ease of tracking and monitoring, What the service does well: What has improved since the last inspection? Two recommendations have been implemented in respect of medication consents and a needle-stick procedure for staff. Staff spoken with indicated 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 6 that the speediness of repairs had improved and any current repairs had been seen and assessed by the maintenance team and were due for repair within a short time. No major repairs are currently outstanding. A damp patch on the second floor landing has now been addressed and redecorated. Outstanding recommendations effecting staff files and individual staff training profiles, changes to the user guide and licence agreement could not be assessed on this occasion in the absence of the manager. 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. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 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 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 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) 1,2,5 Tenants freely express their views of the service but these are still not taken account of within the user guide. The service undertakes a lengthy process of introduction for prospective tenants, but is unable to evidence its own assessment process and how judgements are made as to whether needs can be met within this specific service. Tenants are protected by a licence agreement but minor omissions and a lack of recording around changes mean it is still not in keeping with the National Minimum standards and users rights could be compromised. EVIDENCE: Standard 1- In the managers absence progress made towards implementing an outstanding recommendation in respect of standard 1 could not be assessed. Standard 2 - A prospective tenant is currently having a slow introduction to the service, and it is not envisaged that placement will actually occur for some months. This is an area that the home does particularly well in taking account of the needs of the prospective and existing tenants needs. Documentation viewed indicated that both an application to the service and background reports from health professionals have been provided, an initial assessment in respect of suitability for the service would have been made by HFT care management, however, despite the lengthy introduction period the home were unable to evidence any formal ongoing assessment process which will inform the final decision as to whether the placement is appropriate or not. In view of the high staffing ratio currently in place for this individual, it is recommended 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 9 that consideration is given as to how information from staff in respect of observed needs during the introductory periods are recorded and inform the final decision in respect of placement. Standard 5 - Owing to a change in timescales for the proposed move of the tenants to smaller units at their request, minor changes to the licence agreements which will conform with the national minimum standards are on hold until the move takes place, this therefore remains an outstanding recommendation. A tenant has recently moved rooms, whilst this has not inconvenienced any other tenant and discussion with staff indicated positive outcomes for the tenant, the home could not evidence discussion with the tenant or other stakeholders about the move although it was clearly stated as a goal to be achieved. To ensure that tenants rights are not compromised it is important that all such moves are clearly documented and this is a recommendation on this occasion. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 The service has adopted a person centred care plan format, that reflects personal goals, this needs further development to ensure it is accessible, updated, and provides facilities for endorsement by the tenant. EVIDENCE: Two care plans were reviewed. The Home has adopted a person centred format, since the last inspection these have been incorporated into user files, and has become less accessible and effective. Although files were well laid out, the format was not an easy read and without the important information sheets provided on each file, information about needs would have been difficult to find and inadequate. The stability of the tenant and staff group has created a familiarity by staff with tenant needs and routines, that a new member of staff would not share. Information in respect of goals was available as were details of identified risks in most cases. Discussion with staff indicated that they do not find the format particularly easy to use and it is a recommendation that it is reviewed to see how best this can be improved. On those files viewed, it was noted evidence of regular updating and review was not in keeping with the frequencies proposed in the standards, although less frequent updates were noted. Care plan/PCP information did not provide a facility for tenants or their representatives to endorse the current plan in use. Annual reviews were noted on files, however, these are internal reviews managed by 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 11 HFT and as such there is no evidence of independent endorsement of care plans by funding authorities or representatives. Care plan/PCP and review information did not record self administration of a prescribed cream by one tenant. It is a requirement that Care plans/PCP information is updated a minimum of six monthly, and contain all relevant needs, routines and risk information, the format should also offer an opportunity for tenants or their representatives where necessary to sign their agreement to it. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,17 Tenants are supported to access a range of activities in keeping with their own needs and aspirations within the local community. Tenants are consulted about and influence the development of a healthy menu. EVIDENCE: Documentation viewed, brief discussion with tenants and more in depth discussion with staff indicated that tenants have individualised and varied activities programmes, these include use of in house skills training opportunities and external work, educational and leisure activities in the community. Tenants have weekly meetings, these are recorded, minutes reviewed indicated that menus are featured as an area of discussion on a regular basis. Tenants have agreed that menus can be altered subject to changes in weather. Menus viewed were varied and nutritious. Recording of tenants food intake is undertaken, however, there has been some slippage in this area and it is a recommendation that staff ensure documentation in respect of food intake is maintained. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 13 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, & 20 The Service actively promotes the physical and emotional well being of tenants, some improvements could be made to medication administration systems to ensure the health and safety of tenants is not compromised. EVIDENCE: Tenant files reviewed during the visit indicated access to routine health screenings and checks. More specialised input from health professionals, in respect of psychology, speech therapy, and outpatient appointments etc. were also noted. Tenants weights are recorded weekly. Medication administration sheets were reviewed, and only one recording omission was noted. A list of Homely remedies approved by the Home’s local health centre was noted. An outstanding recommendation that a needlestick procedure be developed has been addressed. Consents to medication are now provided on each user file addressing an outstanding recommendation. Staff have been given accredited medication training, also training to administer insulin, two staff have also been trained to administer rectal Diazepam. Staff handover medication keys at change of shift. A list of staff competent to administer is in place however, a sample of each staff members signature should be available and this is a recommendation. One tenant who administers a prescribed external cream and retains this in their bedroom did not have a risk assessment in place, and it is a recommendation that this is addressed at the earliest opportunity. It is a recommendation that the home makes clear within care plans what `as directed’ instructions for external creams mean to ensure staff are clear in respect of administration. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 15 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, & 23 An accessible complaints system is in place to enable Tenants to express views and concerns. Systems within the Home and staff training are in place to ensure that tenants are protected from abuse. EVIDENCE: An accessible complaints procedure is openly displayed in the Home and tenants have demonstrated confidence in using the procedure in the past. No new complaints have been recorded since the last inspection. Complaints are recorded for individual tenants, in order to summarise the number of complaints received within any given period, it would be necessary to trawl through a substantial amount of documentation, as a consequence it is recommended that consideration be given to the development of a central index sheet at the front of this file to record all complaints received for ease of accounting and monitoring purposes. Discussion with staff indicated that they have received access to training in respect of adult protection and abuse both through their NVQ training and from specialised training offered through HFT. Staff’ spoken with were clear about what steps to take in listening to allegations and reporting alleged abuse. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 The Home offers a clean, safe and homely environment, but further improvements could be made to ensure this is maintained. EVIDENCE: The visit took in a part tour of the premises, which included a view of one tenant bedroom. The Home was clean, and generally well maintained, no unpleasant odours were noted. The Tenants dining room carpet is stained and well worn in some places. It is a concern that the threadbare patches could pose a hazard if not addressed and the Home has identified that replacement flooring is needed, it is a recommendation that this is progressed. A bathroom on the first floor is also in need of updating with décor worn and damaged in places, extensive pipework is also still uncovered and consideration should be given as to covering this to provide a more appealing look. It is a recommendation that consideration is given to the updating of this bathroom. A tenant bedroom that had been redecorated with new flooring involving the tenant was viewed during the visit, concern was expressed at the overly slippery surface of the flooring which could pose a hazard, it is a recommendation that a risk assessment is developed for this bedroom. The garden is pleasantly landscaped with a range of garden furniture for tenant use, staff also use this area for breaks and are allowed to smoke there, 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 18 cigarette butts were noted on the paved area, and it is a recommendation that staff should ensure these are responsibly disposed of in a manner that does not impact unpleasantly on the environment for the tenants. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Systems are in place for the support and supervision of staff to ensure tenants are worked with effectively. EVIDENCE: Staff spoken with during the visit confirmed access to regular, formal and recorded supervision sessions in keeping with expected frequencies and that they have copies of and sign supervision records. Staff spoke positively about the management support they receive, and confirmed regular recorded staff meetings are held. Minutes of meetings were noted at this visit and staff confirmed these are available to staff who may have missed meetings. 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 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) 39, 42 The Home is still to develop systems for collation of tenants’ views and evidencing how these influence self-monitoring and review. The Home ensures systems and procedures are in place to ensure the health, safety and welfare of tenants are protected. EVIDENCE: In the absence of the manager the home’s progress towards developing quality assurance systems could not be assessed. Tenants have some opportunities through tenants meetings to express views in respect of décor, purchases, food, prospective tenants etc. However, the Home has yet to evidence quality assurance and quality monitoring systems are in place which take account of tenant and stakeholder views. Staff daily communication logs indicated reference to servicing for Gas and fire fighting equipment is in place, staff confirmed that fire alarm test and evacuations are happening on a regular basis. An electrician was present in the 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 21 home repairing an electrical fan fault. A review of accident and incidents revealed a low level of tenant accidents within the Home 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 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 4 x x x 3 Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 147 Cheriton Road Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 23 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 6 Regulation 15 Requirement That Care plans/PCP information is updated a minimum of six monthly, and contain all relevant needs, routines and risk information, the format should also offer an opportunity for tenants or their representatives where necessary to sign their agreement to it. Timescale for action 30.9.05 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 1 2 Good Practice Recommendations Service user views to be incorporated into the user guide That consideration is given as to how information from staff in respect of observed needs during the introductory periods are recorded and inform the final decision in respect of placement. That 5.2iii & 5.2vii of the standard are incorporated in with the licence agreement. That discussions relating to Changes of tenant bedrooms are clearly evidenced within tenant plans and contracts changed accordingly. Care plan/PCP format to be reviewed Improvements to be made to the recording of tenant food intake H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 24 3. 5 4. 5. 6 17 147 Cheriton Road 6. 7. 8. 20 22 24 9. 10. 11. 34 39 42 Provide Sample signatures of staff deemed competent to administer medications. Risk assessment to be developed for tenant self administering prescribed cream A central index sheet to be developed to log all complaints for ease of accounting and monitoring Carpet in dining room to be renewed. First floor bathroom to be upgraded. Risk assessment of flooring in tenant bedroom highlighted at inspection. Cigarettes to be disposed of responsibly and tidily within the garden area. Staff files to be compliant with schedule 2 & 4(6) of the care homes regulations 2001 Home to develop quality assurance and quality monitoring systems Home to evidence, fire safety and infection control training for a newer member of the staff team as this could not be established from their personnel file in the Home 147 Cheriton Road H56-H05 S23286 147 Cheriton Road V236347 110705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU 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. 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