CARE HOME ADULTS 18-65
15 Cliffe Avenue 15 Cliffe Avenue Westbrook Margate Kent CT9 5DU Lead Inspector
Brenda Pears Unannounced Inspection 7th February 2006 09:30 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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.V271836.R01.S.doc Version 5.0 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.V271836.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 15 Cliffe Avenue Address 15 Cliffe Avenue 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.V271836.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st September 2005 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 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. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken with a focus on the well being, safety and quality of life for service users living in the home. The methods of inspecting the home included speaking to the acting manager, undertaking a tour of the building and observations of both staff and service users during this time. This report reflects the findings at this visit and the findings of the previous announced inspection. At the time of this inspection one service user was attending a day care centre, one service user was baking cakes and being supported by one member of staff in the kitchen and the remaining two service users were relaxing in the home. Staffing consisted of the acting manager, one RNID carer, one member of RNID relief staff and one agency staff. What the service does well: What has improved since the last inspection?
The home was found to be clean and benefiting from the ongoing redecoration and refurbishment programme that is still ongoing throughout the building. New carpet is now in all hallways and on all stairs, new flooring is now in the dining room and the conservatory area and the lounge has been totally redecorated and refurbished. The lounge is now a comfortable, warm and welcoming area for relaxation and interaction, totally changing the whole feel of this room into a modern and bright space. The service users are enjoying this room and are happy with the changes that have been undertaken. A local maintenance man is currently completing some minor maintenance repairs around the home. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 6 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. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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): 3, 5 The needs of any new service user are assessed before a move into the home and contracts are issued, ensuring full awareness of individual needs. EVIDENCE: Pre admission assessments are undertaken and evidenced on service user files, including information regarding behaviours and guidelines for staff with targets to be attained. Terms and conditions are issued for all new admissions and these contracts are held by the RNID head office. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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): 7, 8,10 Service users are supported to make decisions about their lives to support choice and autonomy. While service users are consulted on how they spend each day and what activities to undertake, the opinions of those living in the home is not obtained when a new admission is being considered, this is not supporting autonomy or a feeling of ownership. All private and confidential information is securely stored, complying with requirements of registration. EVIDENCE: Service users were undertaking chosen activities at this time and these were clearly displayed by pictures/words to confirm what had been chosen by individuals. Staffing levels and routines for the day are developed to support each person’s choices. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 10 The needs of all service users already living in the home must be considered and opinions obtained, where possible, prior to any new person moving into the home. This has not been undertaken in the past and some time must be given for visits and short stays, followed by discussions with those already living in the home, to ensure everyone is comfortable with any new person in the long term. Information is currently stored in the main office area that is locked when unattended and any records kept on the ground floor are also locked. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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): 13,16 Service users enjoy their chosen activities, many of which are undertaken in the community, providing both individual choice and control. EVIDENCE: Likes and dislikes are recorded on care plans and activities chosen by any service user are supported by appropriate staffing levels. Daily routines are chosen by each service user at the start of the day and these choices are displayed on a board in the dining room to reinforce chosen routines. Discussions at this time and previous sampling of records confirm that activities and outings are regularly undertaken in the community. Service users make their own choices regarding where and when these trips are undertaken. One person was due to go bowling later in the day and expressed how excited she was and how much she was looking forward to this trip out.
15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 12 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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 Where needed, healthcare professionals support service users, providing appropriate medical care and ensuring well being. EVIDENCE: Healthcare professionals provide support that enables staff to meet the full care needs of each service user. All service users have access to appropriate healthcare such as dentist and optician and all visits are recorded. Health care needs are met and other agencies such as the Mental Health Team and also National Deaf Services are involved in the support of service users. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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 the following standard(s): 23 The home has organisational policies and procedures in respect of abuse, whistle-blowing and complaints. However, there are currently no local procedures available to support staff and service users. EVIDENCE: While organisational policies and procedures are in place, local procedures need to be developed to support staff in the home when undertaking routines that are specific to 15 Cliffe Avenue. Overall policies describe where the organisation stands and what is hoped to be achieved but staff require specific procedures that describe the exact actions they are to follow in any given situation. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 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 the following standard(s): 24, 27 The home is becoming more homely and comfortable as the ongoing refurbishment and redecoration programme continues. Bathroom and toilet areas do no all provide adequate privacy. EVIDENCE: The home continues to be improved with new carpet in all hallways and on all stairs. The lounge area has been totally refurbished and redecorated, providing a much brighter and comfortable communal room that now provides a homely environment. The dining room and conservatory also benefit from new flooring. There are new doors on all cupboards with new surface tops in the kitchen. Individual rooms are being redecorated and service users are choosing the colour scheme and soft furnishings they prefer. Attention must be paid to minor repairs in the home, particularly to door locks, to ensure the full dignity and privacy of service users at all times. At the time of this inspection the lock on the bathroom door on the first floor was broken. This is totally unacceptable for those living in the home as anyone can interrupt a person using this bathroom at any time, as was the case during this
15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 16 inspection. The repair to this lock could be cheaply and easily carried out, ensuring privacy and dignity is supported at all times. All rooms have flashing lights (strobe lighting) for access that provides privacy and independence while supporting service user needs. A Minicom is also available for communication to ensure contact is maintained with family and friends. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 17 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): 33 The permanent staff team at 15 Cliffe Avenue is not large enough to provide continued continuity and structure for service users. EVIDENCE: The acting manager stated that there are very few permanent members of staff employed to support service users at 15 Cliffe Avenue. There are currently only two members of permanent care staff employed by RNID. Although RNID have a bank of relief staff that are used on a regular basis, a permanent staff team would provide continuity and a more stable environment for all those living at 15 Cliffe Avenue. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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 The home has been very unsettled over the last few months and the acting manager is currently working to provide a stable environment. Quality assurance reviews and continued consultation with service users regarding change in the home are not regularly undertaken. This does not support choice, quality of life or autonomy. EVIDENCE: Due to some unsettled staffing over recent months, service users have not had the benefit of a stable group of staff to support them in the home. Some of this has been unavoidable, but a full complement of permanent staff, instead of the current two permanent staff, would have provided a familiar and constant environment for service users. The acting manager is currently trying to address some recent service user behaviours that appear to have developed following this unsettled period in the home. Undertaking the management of the home has been particularly difficult recently as full information has not always been provided to the acting manager. This is not supporting the
15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 19 management role or ensuring a full awareness of any matters that impact directly on service users and their well being. While service users are consulted about daily routines, regular discussions must be undertaken about any alteration in the homes environment. However this is carried out, continued consultation ensures that all decisions made are beneficial and acceptable to those living in the home. This particularly applies when a new admission is being considered and also after this has occurred, to continually ensure all service users are happy and comfortable about who is living in their home. 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 X 3 X 3 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 2 X 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X 2 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 X X X CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
15 Cliffe Avenue Score 3 3 X x Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X x DS0000023322.V271836.R01.S.doc Version 5.0 Page 21 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 YA8 Regulation YA 10,16,24 Requirement Service users are offered the chance to participate in the running of the home, particularly with regard to new admissions. (Plan of action to CSCI) Timescale for action 31/03/06 2 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. (Plan of action to CSCI) YA 16,23 Redecoration/refurbishment programme continues until the home achieves a good standard in all areas. (Plan of action to CSCI) 31/03/06 3 YA24 31/03/06 4 5 YA27 YA33 YA Appropriate locks must be on all 12,13,16,23 bathroom/toilet areas. YA To provide permanent staffing 12,13,18,19 levels to ensure a constant, stable and familiar environment for service users. This also ensures complete continuity of care at all times. (Plan of action to CSCI) 20/03/06 31/03/06 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 22 6 YA39Y YA 12,13,24 To ensure discussions about the home are undertaken regularly with service users and opinions encouraged. (Plan of action to CSCI) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI 15 Cliffe Avenue DS0000023322.V271836.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
