Inspection on 25/01/07 for 15 Cliffe Avenue

This inspection was carried out on 25th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

15 Cliffe Avenue 16/08/06

15 Cliffe Avenue 07/02/06

15 Cliffe Avenue 14/03/05

15 Cliffe Avenue 30/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

The Royal School for Deaf Children - Westgate College

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

CARE HOME ADULTS 18-65 15 Cliffe Avenue Westbrook Margate Kent CT9 5DU Lead Inspector Brenda Pears Key Unannounced Inspection 25th January 2007 12:30 15 Cliffe Avenue DS0000023322.V326250.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 15 Cliffe Avenue DS0000023322.V326250.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. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 15 Cliffe Avenue Address Westbrook Margate Kent CT9 5DU 01843 232122 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) The Royal National Institute for Deaf People Care Home 5 Category(ies) of Physical disability (5), Sensory impairment (5) registration, with number of places 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2006 Brief Description of the Service: 15 Cliffe Avenue is situated in a residential area with access to Margate and local amenities. The Home is registered for five people with a physical disability and this can be for the long term or as part of a programme for increased independent living. The home has appropriate alerts to fully support people with a hearing loss. The building is a large terraced house and is part of the Royal National Institute for Deaf People (RNID) organisation. The building is in keeping with others in the area and the style and ambience supports the Home’s purpose of providing a home for long term or as a stepping-stone towards independence. The fees for support from the home are set during the assessment period and are very individual to the needs of the service user, depending on the level of support required and the staffing numbers provided. A guide to average fee levels at this time range from a minimum of around £2,000 to a maximum of around £3/4,000 per week or more depending on the support needs as stated. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key unannounced inspection undertaken in this inspection year. Regulatory Inspector Brenda Pears undertook the inspection. The acting manager has been in post for just a few weeks and was overseeing the home, on a temporary basis, for some weeks before that. This inspection was carried out by undertaking a tour of the building, looking at records and files and observations of staff and service users at this time. These observations and discussions with the acting manager support the outcomes and judgements made in this report. What the service does well: The atmosphere in the home was relaxed and very calm, with three service users enjoying various activities including watching television and completing a large puzzle. The home was found to be clean, hygienic and free from odours in all areas and is continuing to be improved through redecoration. Every day is started with service users choosing what they wish to do and service users appeared to be confident and comfortable when dealing with staff and the inspector in the home. Daily activities are clearly shown on the daily planner that is displayed in the conservatory area. The name of the staff members allocated to support service users with various activities is also clearly displayed. Service users are supported to become as independent as possible and to develop daily living skills. One service user is currently working towards becoming more independent and moving into supported living. This has been accomplished with other service users in the past and staff continue to work to ensure such outcomes are achieved. 15 Cliffe Avenue DS0000023322.V326250.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. The summary of this inspection report can 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 8 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 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of any new service user are assessed before a move into the home thus ensuring full awareness of individual needs. EVIDENCE: A new admission is being planned at this time and the acting manager explained that short visits to the home would be undertaken prior to a permanent admission. The person considering moving into the home has visited on a previous occasion but this was some time ago. The inspector was told that following visits and joint meals, the current service users will be asked about their feelings and whether they consider the proposed admission to be suitable. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All care plans are currently being fully reviewed and brought up to date to support the well being of service users. Service users are consulted on how they wish to spend each day and are enabled to be as independent as possible. EVIDENCE: Following the previous inspection, files are currently being reviewed and all care plans are to be fully rewritten. Files seen at this time showed information to be in an orderly format that was easily found using an index. The acting manager explained that new recording systems are in place and being further developed with the staff team. New forms are currently being used and others being developed that are soon to be put into place. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 11 Pictures of all staff have been saved to a computer and these are to be displayed on a board in main hallway. This will clearly show who works in the home and who will be on shift each day and at what time, thereby providing information for service users that will support their independence. Goals are currently being discussed with service users and what steps are needed to be taken to achieve these. Report forms are in place for staff to complete on each shift. These record how far goals have been developed and how much has been achieved each day or at each outing. While staff are working hard to develop new recording methods, they must make sure that all information relating to service users is easily found in the home. Staff must also ensure that all care plans are reviewed on a monthly basis. This is required to ensure all needs are being met in the appropriate way by all staff. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy their chosen activities, many of which are undertaken in the community, providing both individual choice and control. Links with family and friends are supported and encouraged. EVIDENCE: Every day is started with each service user choosing what they wish to do. All daily activities were clearly shown on individual daily planners that are displayed in the conservatory area with the details of the allocated staff member. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 13 Some service users visit outreach services and one person was undertaking a ‘house day’. This includes cleaning their room, dealing with washing, shopping and often includes a lunch outside the home. One service user has an individual programme for developing and maintaining a move to supported living accommodation. This has been recorded on the care plan as a set goal with steps on how this is to be achieved. All food eaten is now recorded on a chart that is on each shift record. Service users choose what food they eat and any alternatives chosen are also recorded. If records show that the intake of food has decreased, then this is automatically referred to the GP. At this inspection, one service user was watching television, two people had previously completed their paper round that morning and another service user was working on a large puzzle. The acting manager is currently overseeing the review of all activities and support plans. Examples of some new formats for recording were seen at this time. The acting manager explained that staff were deciding if this new recording actually worked or if it needed adjusting. Care plans contained information that included pictures of the service user, their behaviours, skills, medication, strengths, communication and teaching plan. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Healthcare professionals support service users, providing appropriate medical care. Staff consider the physical and emotional needs of service users and a review of all records is now developing appropriate support for service users. EVIDENCE: Medication has been fully risk assessed and the acting manager is working towards medication being stored in individual rooms and to be actually administered in service users’ rooms. Discussions were undertaken about the keys to the medication storage and the current practices comply with requirements. One service user has had ongoing medical checks and treatment is planned. This has been fully explained to the person concerned and is clearly recorded 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 15 on the care plan with Widget symbols to enable a fuller understanding to be reached. Staff are currently working on epilepsy procedures and also on an appropriate policy for the home. The epilepsy nurse is assisting with this procedure to fully support the specific needs of one service user who has been experiencing seizures. Again, records are being developed by staff to ensure all records are appropriate and current for each service user. This is an ongoing process for staff and the acting manager is overseeing and checking all records as they are developed. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Following previous poor recording systems, the recording of complaints and comments is currently being developed in the home. EVIDENCE: Staff ensure the safety and well being of service users is considered in the home. Observations confirm that staff support service users in an appropriate way, with due consideration for dignity and choice. The home has organisational policies and procedures in respect of abuse, whistle blowing and complaints. The current acting manager is developing the appropriate recording of complaints. Various formats are being used to provide service users with this information in a way that fully supports them. Discussions were undertaken about obtaining information from visitors. Any systems used must fit into the home environment while enabling anyone to feel able to voice their opinions or concerns. The attention to informing all agencies, where necessary, through appropriate regulation 37 reports has improved. The acting manager stated that two signatures are recorded to support all service user financial transactions. Staff members on each shift sign to accept responsibility for all money and mediation. Any incidents are also noted on handover records to ensure all staff aware of any occurrences. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 17 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was found to be clean in all areas at this time and service user rooms reflected individual taste and choices. EVIDENCE: The dining room has been redecorated with the colour chosen by service users and there is now one large dining table. This helps service users to share activities as well as mealtimes and now provides a larger, brighter space in this room. Areas that have been identified for redecoration include service user rooms, the hallway and the communal lounge. A new kitchen is to be installed and the garden sheds are to be replaced with a new summerhouse to provide additional communal space for service users to enjoy. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 19 The office area is in the process of being redesigned. A new desk is to be installed, files are being condensed to provide more space and the sleep in bed is being replaced with a permanent bed for sleep in staff. At this time, pump soap and paper towels were in place to ensure the control of infection. The conservatory has a monthly planner on display to inform service users and staff of planned activities and which members of staff are dealing with these. The acting manager stated that any staff smoking takes place in the garden and staff are not permitted to smoke in any area of the home. A review of the keypad access to kitchen is to be undertaken by staff, with due consideration for current service user needs and safety. All previously identified risks posed to service users in the home have now been addressed and eradicated. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,24,25 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff consider the dignity and choices of service users. The staff team is currently being strengthened following a recruitment drive. EVIDENCE: Staff were seen to be supporting service users in an appropriate manner, with due consideration for choice, privacy and dignity. The acting manager has undertaken a recent staff team meeting and minutes on display in the office area show the action points that have been decided. One action identified is a full health and safety audit for home, which is currently being carried out. Supervision has been started with all staff and is almost complete. The organisational head office obtains all paperwork for new staff and copies are issue to the home to keep on files for evidence. The inspector was shown files that have been reviewed and now contain the required paperwork. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 21 All core training is now up to date and booked training includes first aid and managing epilepsy. Risk assessment training is to be undertaken, as is mental health awareness and COSHH and health and safety. Further training will be informed by the full review of all care plans and continued development of activities. Rotas are written for one month ahead to support activities, service user choices and to ensure staff cover is appropriate. This gives time for any gaps to be filled in staffing levels. Four staff are always on shift every morning and shifts are divided during other parts of the day with two staff being on shifts that overlap each other. The acting manager is not on rota for care shifts, unless absolutely necessary. On duty at inspection were three care staff and the acting manager was covering sick leave. The night shift consists of one member of sleep in staff. Staff shifts have been adjusted to provide shorter shift patterns for staff. Rotas clearly identify the shift leader (in bold) and the home is working to eliminate the use of agency staff. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The newly appointed acting manager has appropriate experience to manage the home and is addressing previously identified requirements. EVIDENCE: Previous management of 15 Cliffe Avenue has been erratic and service users have experienced many changes of staff. RNID is working to address this problem and a new acting manager is now in place. The newly appointed acting manager has 25 years care experience. He has worked with a psychiatric unit in Nottingham. After moving to Eastbourne he worked with a community mental health team. He later managed a residential 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 23 unit for people with learning disabilities and mental health problems. In May 2006 he joined RNID and recently relocated to Thanet to take up the post at 15 Cliffe Avenue. All health and safety matters from the last inspection have been addressed. It was previously seen that the home has organisational policies and procedures in respect of abuse, whistle blowing and complaints, but no local procedures. The home is now working to develop these to fully support the current service users. Staff are working to address all areas that need attention in the home. This will provide a good foundation to develop and improve the safety and well being of service users in the home. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 X 2 X X 3 x 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation YA 15, 17 Requirement A full review of service user files to be completed and evidenced on a monthly basis. Brought forward from last inspection. 2. YA8 YA 10,16,24 Service users are offered the chance to participate in the running of the home, particularly with regard to new admissions. Brought forward from last two inspections. Plan of how this will be undertaken and evidenced on records to CSCI by date stated. 3. YA23 YA Local procedures are to be 12,17,20,22 developed to support staff in their duties, to support the induction process and to protect/support service users. Brought forward from last two inspections. 31/03/07 31/03/07 Timescale for action 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 26 Plan of action to CSCI by stated date 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations For the refurbishment programme to continue until all areas of the have been addressed. 15 Cliffe Avenue DS0000023322.V326250.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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