Inspection on 15/06/05 for 2 Littlefield Gardens

This inspection was carried out on 15th June 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Littlefield Gardens 17/11/06

2 Littlefield Gardens 20/06/06

2 Littlefield Gardens 14/12/04

2 Littlefield Gardens 02/08/04

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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 Littlefield Gardens (2) Ash Guildford Surrey GU12 6LN Lead Inspector Sandra Holland Unannounced 15 June 2005 10:00am 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. Littlefield Gardens (2) Version 1.10 Page 3 SERVICE INFORMATION Name of service Littlefield Gardens (2) Address 2 Littlefield Gardens Ash Guildford Surrey GU12 6LN 01252 318968 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Paul Hewitt Atlas Project Team, Old Quay House, Old Quay, Teignmouth, Devon, TQ14 8ES To be confirmed Care Home (CRH) 3 Category(ies) of Learning disability (LD), 3 registration, with number of places Littlefield Gardens (2) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 30 - 50 years Date of last inspection 14 December 2004 Brief Description of the Service: Littlefield Gardens is a small care home accommodating three service users who have learning disabilities and whose behaviour is challenging, and are aged between 30 and 50 years. The home is situated in quiet residential cul de sac in Ash, near Guildford. It is managed and staffed by Atlas Project Team. T.A.C.T. (Thames and Chiltern Housing Association owns and manages the property). The building is single storey and comprises a communal lounge, dining area, kitchen and bathroom. There are three single bedrooms, one with an en-suite bathroom and a snoozelam, relaxation room. Externally there is an enclosed rear garden with small patio and a garage to the front, which is used mainly for storage. Parking space is available on the driveway and to the front of the property. The home is close to local amenities, including shops, library and pub and is well served by public transport. Littlefield Gardens (2) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first to be undertaken in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006 and took place over three hours. The inspection was carried out by Mrs. Sandra Holland, Lead Inspector for the service. Ms. Karen Skoglund, Acting Manager was present representing the service. A tour of the premises was carried out and a number of records and documents were examined, including care plans and staff files. The inspector met with all three service users and spoke to the three staff on duty. The inspector thanks the service users and staff for their hospitality and assistance. What the service does well: What has improved since the last inspection? What they could do better: The home has not had a registered manager for a number of years, as the manager previously in post did not apply for registration with CSCI. The home now has an acting manager who is planning to apply for registration with CSCI. The organisation must confirm the appointment of a manager for the home, must notify CSCI of the appointment and the appointed manager must apply for registration with CSCI. It is required that the results of the recent quality survey are sent to CSCI. Littlefield Gardens (2) Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Littlefield Gardens (2) Version 1.10 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 Littlefield Gardens (2) Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4. Prospective service user’s needs would be fully assessed and they would have the opportunity to visit the home before making the decision to live there. EVIDENCE: The current group of service users have lived together at the home for approximately thirteen years and two of the service users lived together prior to that, at a previous residence. As a result there have been no new service users into the home. The acting manager and deputy explained the assessment and admission process. It was made clear that any new service user would be introduced to the current service users very slowly, to minimise disruption to the routines and relationships of the existing group. The assessment of a prospective service user would be comprehensive and involve healthcare specialists to ensure that the home could meet all specified needs. Littlefield Gardens (2) Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9. A comprehensive personal plan is in place for each service user. EVIDENCE: A detailed plan of the support each service user requires is drawn up to guide staff and to record the support provided. This was seen to cover a wide range of needs including personal care/hygiene, communication, behaviours and activities. Guidelines are provided to outline the specific support that is required to manage stated incidents or behaviours. A chart is maintained to record all types of activity that each service user is involved in, both at home and outside the home. This enables the service user and staff to note any gaps in activity and avoid repeated activities. Service user’s key workers are responsible for keeping individual plans up to date. They review these on a monthly basis and make a monthly report. This report looks back over the whole month to reflect on goals and activities, measuring and recording achievement. Any area of risk to a service user is assessed and documented. Risk assessments measure the extent of the risk and state what can be done to Littlefield Gardens (2) Version 1.10 Page 10 minimise the risks, from service user’s aggression, for example. These are updated annually or sooner if there is any change. A record of review dates is maintained and was seen in the individual plans. Service users who have communication difficulties are supported to communicate in appropriate ways, such as the use of communication boards. Littlefield Gardens (2) Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) and 15. 11, 12, 13, 14 Service users are active participants in the community and take part in a range of activities. EVIDENCE: It was clear that staff provide opportunities for service users to develop their life skills and to be part of the local community. A service user was supported to make refreshments and another who requested to go for a walk, was supported to the post box to post a letter. Service users are frequent and well-known visitors to local shops, post office and library. Occasional visits to the pub and trips on local buses and trains are popular. Staff advised, and a service user confirmed, that classes are attended on a daily basis. Some classes teach life skills such as cooking and others are for enjoyment such as line dancing and pottery. An aromatherapist visits the home regularly to provide relaxation sessions. Littlefield Gardens (2) Version 1.10 Page 12 The home has a Snoozelam sensory room, which provides a calm and relaxing space for service users to enjoy. The Snoozelam is a system of soft and changing lights, with colourful bubble tubes and music. Service users can have at least one holiday a year and some had been away already. These are arranged individually to ensure that service users have breaks from each other. Individual preferences are considered and service users are encouraged to take part in the planning of holidays or days out. Staff advised that one service user prefers not to stay away on holiday, so a number of day trips to places of interest are organised with the service user. All service users are involved with their families and one service user goes to stay with family for short visits. Littlefield Gardens (2) Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19. The healthcare needs of service users are well met. EVIDENCE: Personal support was seen to be provided sensitively and discreetly. Service user’s preferences and requests are listened to and were acted upon. Staff advised that they have provided a high level of support to one service user who has had very specific and challenging needs, for nearly three years. A keyworker system is in place to ensure consistent support. The acting manager advised that the service users are supported with their healthcare needs by a number of local healthcare professionals, including a general practitioner (G.P.), dietician, speech and language therapist, psychiatrist, optician and community dentist. Other specialists are involved in supporting the service users as required. Service users usually go out to attend appointments with the specialists but if service users are too unwell, staff would request a home visit from the G.P., for example. Appointments or visits to any healthcare professional are recorded in the individual’s care plan. Littlefield Gardens (2) Version 1.10 Page 14 Littlefield Gardens (2) Version 1.10 Page 15 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) 23. Staff are aware of their role and responsibilities to protect service users. EVIDENCE: From speaking to staff it was evident that they are aware of and understand their part in protecting the service users in their care. The acting manager advised that training in the Protection Of Vulnerable Adults (POVA) is included in the induction of new staff and is carried out at the organisation’s regional office. A new member of staff advised that a POVA training course had been arranged for her to attend. Staff are also trained, the acting manager stated, in the management and prevention of challenging behaviour. The aim of this training is to anticipate challenging or aggressive behaviour and to create diversions to prevent the situation developing. The acting manager advised that only she and the deputy manager are signatories to service user accounts, to protect service users from financial abuse. Littlefield Gardens (2) Version 1.10 Page 16 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) 28 and 30. 24, 25, 26, 27, The overall décor and furnishings in this home provide a well-cared for and homely environment for residents. EVIDENCE: From observation it was clear that the home is suitably decorated and maintained and a maintenance programme has been drawn up and was seen. Furnishings and fittings meet the needs of the service users and all were of a family style. The home was clean, tidy and freshly aired. Each service user has a single bedroom and one bedroom has an en-suite bathroom. Another bathroom is available for general use and both were seen to be clean and hygienic. Bedrooms have been decorated to suit the tastes of the individual and have been made personal with pictures, soft toys and other items. A service user happily showed me her bedroom, which was attractively decorated. A spacious lounge with open plan dining room provides adequate communal space and this opens through patio doors onto an enclosed garden. The Littlefield Gardens (2) Version 1.10 Page 17 garden is planted with hedges to provide screening and on the day of inspection the patio was covered with a gazebo to provide a shaded area. Littlefield Gardens (2) Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36. 31, 34, 35 and Recruitment procedures are effective, staff are aware of their roles and they are appropriately supervised. EVIDENCE: Staff files were seen to contain all the required records and documentation, including job descriptions. Criminal Record Bureau (CRB) checks are carried out and documents seen confirmed this. The acting manager stated that new staff work alongside another member of staff until a CRB clearance is obtained. The induction of new staff into the home takes place over the first year of employment, the acting manager advised. Staff also undertake a specific Learning Disability Award Framework (LADAF) induction over a twelve week period. Staff spoken to confirmed that they are well supported by the home’s management and receive regular formal supervision. Records held confirmed this. Littlefield Gardens (2) Version 1.10 Page 19 Littlefield Gardens (2) Version 1.10 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) 37, 38 and 39. The management of the home is open and inclusive. It is to the service user’s benefit that the acting manager has known them for many years. EVIDENCE: The acting manager advised that she has been involved in the support of the current service users for approximately nine years and that most staff at the home have been employed for approximately two years. It was clear from observing the working relationships between staff and service users, that there is an open and mutually supportive atmosphere. The previous manager at the home left earlier this year, having been in post for four years, but without registering with CSCI. The present acting manager has been the area manager for this home and another local home within the same organisation, for a number of years. It was advised that the acting manager has recently undertaken an Applied Behaviour Analysis course to develop her knowledge and skills. She stated that she now proposes to apply Littlefield Gardens (2) Version 1.10 Page 21 for registration with CSCI as the home’s manager. It is recommended that this process commences within six months to ensure continuity of management. The acting manager advised that a quality survey was carried out in February to March 2005 to assess people’s views on the service provided. This was sent to families and friends of service users and health care professionals, who are involved in the support of the service users. It was reported that most replies were positive, but the results are being reviewed and were not available to see. It is required that the results of the survey are sent to CSCI, Eashing office. A requirement and a recommendation have been made – please see page 25. Littlefield Gardens (2) Version 1.10 Page 22 Littlefield Gardens (2) Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score 3 x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x x x x Littlefield Gardens (2) Version 1.10 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA37 Regulation 8(1) 8(2) 9 Requirement The registered provider must proceed with the formal appointment of an individual to manage the care home in accordance with the requirements of Regulations 8 and 9 of The Care Homes Regulations 2001 (As Amended). The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving, the quality of care provided at the home. A report in respect of any review must be supplied to CSCI and made available to service users. The review system must provide for consultation with service users and their representatives. Timescale for action 16th September 2005 YA39 24 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 Littlefield Gardens (2) Version 1.10 Page 25 1. 37 It is recommended that the appointed manager should submit an application for registration with the Commission for Social Care Inspection without delay. Littlefield Gardens (2) Version 1.10 Page 26 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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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