CARE HOME ADULTS 18-65
Pentire Crescent (15) Pentire Crescent (15) East Pentire Newquay TR7 1PU Lead Inspector
Lowenna Harty Unannounced Inspection 6th February 2006 09:30 Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Pentire Crescent (15) Address Pentire Crescent (15) East Pentire Newquay TR7 1PU 01326 371000 01326 371099 mark.pearce@dcact.eu.com 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) Spectrum Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: 15 Pentire Crescent is a home providing accommodation and personal care for up to 3 adults with a learning disability. The home is run by Spectrum, an organisation that provides care for people with autistic spectrum disorders. Spectrum employs a manager and a team of care staff to provide care to service users on a day-to-day basis. The aim is to provide them with the support they need in a homely, domestic-style environment. The home is located in Newquay and as such service users are able to access all the facilities of a small town with the added advantage of ready access to several local beaches. The house is a detached, two-storey building, with a large garden. Service users are provided with their own bedrooms, one of which has an en-suite bathroom. There are two additional bathrooms. All the bedrooms are on the ground floor of the house. The home has an office and a separate sleeping in room for staff. There is a domestic-style kitchen with open plan dining room and conservatory, a separate laundry/store room downstairs. There is also a workshop that service users are able to make use of. On the first floor of the building there is a large, comfortable lounge, with TV, Video, music centre and a computer with internet access for service users to make use of. The home does not specifically provide accommodation for people with physical or sensory disabilities, but could readily adapted to meet special needs, if required. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 6 February 2006 and lasted for approximately four hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. The inspection focused on an inspection of the premises, examination of care, safety and employment records and discussion with the manager. There were opportunities to observe the daily life of the home and staff interaction with the service users. Because of the small size and nature of the home it was possible to review each of the service users’ records in detail and follow this up with individual interviews with two of them, which were held in private. The third service user was out of the home, at their college placement at the time of the inspection. The home provides good to the service users placed there, which they confirmed during the interviews. There was evidence of improvement at this inspection, with most of the requirements and recommendations set at the last inspection having been met. What the service does well:
Service users have detailed written care plans, which set out their needs and how they will be met. Service users are given information about them and attend reviews regularly, so that they know why they are placed at the home. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Service users have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and of what to do if they wish to make a formal complaint about something they do not like. Service users interviewed at the time of the inspection said that they are mainly satisfied with the food provided to them at the home. They take it in turns to choose menus and buy food for the household and help staff to
Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 6 prepare the main evening meal. They have free access to the kitchen so that they can make drinks and snacks for themselves when they wish and are encouraged to live and eat healthily. Service users are appropriately supported with their personal care so that they maintain their dignity. They looked smart and fashionably dressed at the unannounced inspection and staff helped them to attend to their needs quietly and unobtrusively. The home’s environment is suitable for the service users living there. It was clean and tidy throughout at the time of the unannounced inspection and provides an ordinary, domestic dwelling for service users to develop their skills and independence, with unobtrusive support from staff. The home’s staff team has sufficient numbers of qualified staff to meet service users’ needs and they have access to regular training to maintain their knowledge and skills. The home is well managed by an experienced and competent manager, who is in the process of applying to be registered with the Commission as a fit person to be in charge of this particular home. She ensures that activities service users engage in and the home’s environment are kept as safe as practicable for them. What has improved since the last inspection?
Service users have better, more up-to-date written information about what the home formally sets out to provide them. The statement of purpose now provides accurate information about the management and staff, including staff qualifications, so that they and their relatives can decide whether the home is suitable for them. This information is also useful for prospective service users, although there are no current vacancies at this particular home. The home has introduced safer systems to manage service users’ medicines to protect them from medication errors. The systems in place, including guidance for staff and training, are suitable to meet the needs of the service users currently placed at the home. The registered provider has now consulted with service users and their representatives on their wishes in the event of serious illness or unexpected death so that they can be respected. There are improved practices to protect service users from the risk of harm through a fire in the home. The home’s written fire safety risk assessment has been completed, staff are trained in the fire safety procedures and equipment is regularly tested and checked. There are fire drills in accordance with the home’s written procedures. Spectrum has introduced a five-day induction programme for all new staff, to ensure they have the basic knowledge and skills they need to work safely and effectively with service users. There are improved records of staff training so
Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 7 that the home’s manager can plan duty rosters and staff development plans around service users’ needs. 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. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Service users are provided with good information about the home so that they know it will be suitable for them. EVIDENCE: The home’s statement of purpose provides up-to-date information about the home, including information on management and staffing, and a copy of it is attached to the service users’ notice board in the hall. It is provided to service users in a format that is suitable for them. There is clear information on the admission criteria and other important aspects of the home that affect service users. There have not been any recent admissions and current service users are very familiar with the services provided at the home. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 the following standard(s): 6, 7 & 9 Service users’ assessed and changing needs are reflected in their individual plans but there should be more detailed and specific goals for them to achieve so that they are clear about the reasons for their placements in the home. They have opportunities to make decisions but specific improvements are needed in this. They are supported and encouraged to take risks in a safe way, to develop their skills and independence. EVIDENCE: Service users’ written care plans address all their personal, health and social care needs, including needs related to their backgrounds, culture and religion. They are shared with service users and their representatives, signed by them and regularly reviewed. Although goals are set in broad terms, there should be more detailed and specific goals set to assist service users develop their skills in activities of daily living to maximise their independence. Service users’ care plans consider their abilities to make decisions for themselves and risk assessments set out any restrictions necessary to protect their health and welfare. Service users interviewed at the time of the inspection confirmed that they are able to make choices about issues that are important to them. One service user requested that a lock is fitted to their
Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 11 bedroom door. This must be done unless there are specific risks to suggest that this would not be in their best interest. Service users’ written risk assessments and daily care records provide evidence that they are able to take risks in safe ways, to develop their independence. They and/or their representatives should be asked to sign them as evidence of their agreement with their contents. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 the following standard(s): 16 & 17 Service users are aware of their rights and responsibilities regarding their placements in the home. They are provided with a healthy, balanced diet. EVIDENCE: Service users’ rights and responsibilities in relation to their placements in the home are set out in their service users’ guides and individual contracts and their personal care plans, all of which they sign their agreement to. There are copies on their personal files, which they are able to access if they wish. Service users have clear information on what is expected of them, for example with regard to assisting with household tasks, to help them develop their independence and skills. Service users’ care plans consider their dietary needs and preferences. They each take it in turns to plan the main evening meal menus for a week and go shopping for food. They take it in turns to help prepare meals for the home and prepare their own breakfasts, lunches and snacks between meals. They are encouraged to take exercise and eat a healthy, balanced diet so that they stay well. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 13 Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 the following standard(s): 18, 20 & 21 Service users are appropriately assisted with their personal care to maintain their dignity and independence. There are suitable systems in place to protect them from medication errors. Staff are aware of their wishes in respect of their ageing, illness and death. EVIDENCE: Service users’ individual care plans consider their personal support needs and there are suitable and sufficient bathrooms for them to attend to, in privacy and dignity. Service users interviewed at the time of the inspection looked smart and fashionably dressed. The home has suitable written procedures and controls in place to protect service users from medication errors, in keeping with the nature of the needs of service users currently placed in the home. This includes basic training for staff in the medication systems used there. Service users are currently young and in good physical health. The home’s manager is aware of their wishes in respect of their unexpected serious illness or deaths. There are written procedures for staff on what they should do to ensure that service users’ wishes are observed.
Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 15 Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 the following standard(s): 23 There are good systems in place to protect service users from abuse, neglect and self-harm but a specific improvement is needed. EVIDENCE: The home has written guidance for staff in the form of internal written policies and procedures and copies of the multi-agency procedures from the local authority and placing authorities of service users in the home. There is evidence that staff are recruited on the basis of fair, safe and effective procedures and their suitability to work with vulnerable adults in a care setting. Service users interviewed at the time of the inspection confirmed that they are well cared for in the home. Spectrum’s internal written procedures on the protection of vulnerable adults from abuse should be reviewed and updated, as they are out-of-date. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 the following standard(s): 24 The environment is comfortable, homely and safe for service users to develop their independence in an ordinary, domestic setting. EVIDENCE: The home is conveniently located so that service users can access local amenities easily, including shops and public transport. It appeared clean and tidy throughout at the time of the unannounced inspection. It is an ordinary, domestic dwelling, suitable to meet the needs of the service users placed there so that they can fulfil their care plans. There is evidence that the home has been formally assessed for risks to service users and there are suitable systems in place to protect them from fire. This includes a written fire safety risk assessment, and records to show that staff have undergone training in the home’s fire safety systems. There are records to demonstrate regular tests and checks of equipment and evacuation drills in accordance with the home’s procedures. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 The home has sufficient qualified staff to meet service users’ needs. They have good access to regular and ongoing training so that they can maintain and update their knowledge and skills. EVIDENCE: Half of the current staff team have completed training to achieve qualifications to NVQ level 2 or above, in accordance with the recommended National Minimum Standards. The rest are undertaking training to achieve this. Basic training for new staff has improved with the introduction of a five-day induction programme, which covers essential aspects of keeping service users safe and well cared for. There is an ongoing training programme so that all staff are able the gain the training and skills they need to perform their work effectively and keep them up-to-date. Records of staff training are maintained on the home’s computer database so that the home’s manager can effectively plan staff training and duty rosters to meet service users needs. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 19 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 & 42 The home is well managed and run for the benefit of the service users. It is managed to promote and protect service users’ health, safety and welfare. EVIDENCE: The home’s manager has submitted an application to the Commission to be registered, which is currently being determined. She has extensive experience of working for Spectrum and has worked as a manager at other Spectrum homes. She is in the process of completing her NVQ 4 in management and undertakes regular training to update her knowledge and skills. There are written risk assessments to address specific activities that service users engage in with risk management plans to ensure their safety as far as is reasonably practicable. There is a written risk assessment to prevent accidents in the home’s environment and suitable systems in place to protect service users from the risk of fire. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 X 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 X 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 3 3 X X X X 3 X Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 12(4)(a) Requirement Service users must be provided with lockable bedroom doors unless records indicate that it is unsafe for them or they do not wish to have them. Timescale for action 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA9 YA23 Good Practice Recommendations Service users’ care plans should contain more specific and detailed goals to help them develop their skills activities of daily living and maximise their independence. Service users and /or their independent representatives should sign their risk assessments as evidence of their agreement with the contents. The home’s written procedures for the protection of vulnerable adults from abuse should be reviewed and updated. Pentire Crescent (15) DS0000028263.V282873.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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