Inspection on 17/11/06 for 2 Littlefield Gardens

This inspection was carried out on 17th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

2 Littlefield Gardens 20/06/06

2 Littlefield Gardens 15/06/05

2 Littlefield Gardens 14/12/04

2 Littlefield Gardens 02/08/04

Similar services:

Lyncol House

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Littlefield Gardens (2) 2 Littlefield Gardens Ash Guildford Surrey GU12 6LN Lead Inspector Cathy Clarke Announced Inspection 17th November 2006 10:00 Littlefield Gardens (2) DS0000013462.V321191.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 Littlefield Gardens (2) DS0000013462.V321191.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. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 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 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) Atlas Project Team Limited Karen Jane Skoglund Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 30 - 50 years 22nd November 2005 Date of last inspection 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 of 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) DS0000013462.V321191.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 inspection in the Commission for Social Care Inspection (CSCI) year April 2006 to 2007 using the new ‘Inspecting for Better Lives’ (IBL) process. Lead Regulation Inspector Cathy Clarke and Regulation Inspector Kenneth Dunn were assisted throughout the inspection by Mr Tim Stevens, Mr Jolyan Marshall and Mrs Penny Davey representing the establishment. The IBL process involves a pre-inspection assessment of service information from a variety of sources. Initially helping to prioritise the order of inspections and identify areas that require more attention during the inspection process. Details from each source of enquiry are compiled in a new form of inspection record used by the Inspector throughout the inspection process. A presentation on the new IBL Inspection methodology was given to Mr Tim Stevens, Mr Jolyan Marshall and Mrs Penny Davey. The inspection of 2 Littlefield Gardens took place over a period of 4½ hrs during which samples of; care assessments, care plans, and staff records were inspected. All of the key inspection standards for younger adults were assessed. One survey was received back from a health care professional and feedback is included in this report. A pre-inspection questionnaire was received from the service and some of the information from this document will be referred to in this report. The inspectors met with all three service users and their body language, facial expressions and verbal responses were observed throughout the inspection. The fees for the service range from £1708.29 to £2688.31 per week. The inspectors would like to extend thanks to the management and staff of 2 Littlefield Gardens for their assistance and hospitality during the inspection. What the service does well: The service offers care to service users with complex care needs in a way that promotes their individual choice and dignity. The management team of the organisation is very supportive of the service and there are six behavioural therapists employed by the organisation. Care plans and service user records are detailed and support staff with the information required to deliver the support needs of service users. The service is to be commended for the information available to staff for the care of service users. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 6 Risk assessments are in place to support staff in protecting the health and welfare of service users. Family and representatives are actively encouraged to visit and take a full and active part in the service users lives. The support and assessment for one service user with complex nutritional needs have been monitored and met with very positive outcomes for the service user. The service is to be commended for its work with this service user and her nutritional requirements and continual monitoring and support. 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 be made available in other formats on request. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 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 Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards inspected: 1, 2,3,4,5 This judgement has been made using available evidence including a visit to this service. Comprehensive information giving an informed choice is available for prospective service users wishing to enter the home. The policies and procedures of the home underpin the admission process. EVIDENCE: The statement of purpose contains comprehensive information on the aims and objectives of the home. This was revised in October 2006. There are operational procedures in place for new admissions to the home. The current service users have resided at the home since it was opened. The interim manager stated that new service users would be invited to the home over a period of visits and that staff would visit the service user in their previous care environment to assess their suitability. There are a set of service principles, which promote continued growth and development, good relations with others in the community, choice, diversity and flexibility. Guidance for staff is available on the transfer of people from a hospital setting to a home in the community. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 9 Each service user has a statement of the terms and conditions of residency including a contract. The total fees payable are included. This also includes any payment from benefits that the service users may receive. Littlefield Gardens (2) DS0000013462.V321191.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): Quality in this outcome area is good Standards assessed 6,7,9,10. Standard 6 is assessed as excellent. This judgement has been made using available evidence including a visit to this service. There is extensive information available for staff on the assessed needs of service users and their goals and aspirations are taken into account when conducting risk assessments. Information is stored appropriately. EVIDENCE: Comprehensive assessments are in place for all service users in the home. These are person centred contain a recent photograph of the service user and the service is in the process of completing a passport to communication for each of the service users. Plans include service users goals in life and any aspirations that they may have. On the day of inspection the service users were attending various activities in the local community. Information relating to the care for service users and the monitoring process is to be commended. A contact sheet is included for interactions with health care professionals including, care management, psychologists, psychiatrists and the dietician. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 11 One of the service users has a pen picture, which illustrates that her individual choices and all aspects of her life have been assessed and risk managed. There is close liaison between the service and the local authority care management team. Care plans have been reviewed with the local authority care management service however these have not always been forwarded to the service in an appropriate timescale. The interim manager has stated that she will request a recent copy. One of the service users has received support from a Professor on Autism to ensure that all aspects of her care have been provided. A holiday abroad was cancelled for one of the service users following a health risk assessment. Information relating to service users is kept confidentially in lockable storage cabinets within the office in the home. Littlefield Gardens (2) DS0000013462.V321191.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): Quality in this outcome area is good Standards 12,13,15,16,17 Standard 17 is assessed as excellent This judgement has been made using available evidence including a visit to this service. Service users take part in various activities in the local community and have regular contact with family. A healthy diet is provided and excellent support is offered to one service user with complex nutritional requirements. EVIDENCE: Service users have a weekly activities chart and a “keeping tracks chart” to record all interactions was seen for one service user during the inspection. On the day of inspection the service users were in and out of the home during the day taking part in various activities in the local community. One service user had been shopping with staff in the morning and was going out for lunch with his mother. Another had a day at home but spent her time assisting staff with the shopping and enjoying an outing. The third service user was attending a regular college day. Therapy planning meetings are undertaken. One of the service users enjoys cookery lessons. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 13 The service has two vehicles at its disposal and it was stated by a member of staff that this allows greater flexibility in the styles of activities open to the service users. The inspectors were informed that all of the service users regular activities are fully community based, ensuring that they gain from the experience of integration. SH and SM are both active members of a rambling group this is in conjunction with another service. The rambling group make regular outings enjoying social gatherings and lunch. Activities include attendance at sports centres, adult education facilities, libraries, restaurants, pubs, shops, going to the bank, holidays and days out. Family regularly visit the home. A varied diet is provided for service users and a monthly menu plan is devised. One service user receives extensive input into her dietary requirements and her weight and progress is monitored very carefully. Staff observe any patterns arising from any weight loss. The service works in close liaison with a dietician who is regularly involved with the service users care. The service is awaiting confirmation that a monthly dieticians clinic appointment will be conducted for this service user. The service is to be commended for its input into the nutritional needs of this service user. Littlefield Gardens (2) DS0000013462.V321191.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): Quality in this outcome area is good Standards assessed 18,19,20 This judgement has been made using available evidence including a visit to this service. Personal and healthcare support is provided with respect and privacy is provided. The service users physical and emotional health care needs are met. Medication practices within the home are good however the service needs to reassess their medication process for planned activities outside of the home. EVIDENCE: Service users receive personal support according to their plan of care and needs. The home has a good relationship with local health care professionals and one has stated that the home communicates clearly and works in partnership and there is always a senior member of staff to confer with. The health care professional has also stated that they are able to see service users in private and that staff demonstrate a clear understanding of the care needs of service users. Specialist advice is incorporated into the care plan. Service users have received dental visits and appointments with nurses, GPs and are reviewed by the General Practitioner if the need arises. Other health care professionals involved in the service users care include psychologists and psychiatrists. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 15 There is a monitored dosage system in place and medication administration records were correct at the time of the inspection. One service user needs to carry medication in case treatment is required. Staff have been trained to administer rectal diazepam and guidelines are in place. Medication training has been delivered and drug assessment training. Some staff has undertaken a distance-learning programme. Staff signatures are in the medication folder. The medication keys are kept in a locked cabinet. No controlled medication is used. Staff sign out medication and one service users medication is put into a dossett container. Discussion was held with the interim manager on the practice of secondary dispensing and it was recommended that the practice be reviewed and risk assessed. The outcome of the review should promote the independence of service users whilst protecting both staff and service users from any medical errors. Please see recommendations section of this report. Littlefield Gardens (2) DS0000013462.V321191.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a complaints and protection of vulnerable adults policy and procedure in place. EVIDENCE: There have been three complaints relating to parking facilities since the last inspection and these have been responded to using the homes complaints policy and procedures. No complaints regarding the care and welfare of service users have been made. There is a protocol in place for reporting abuse and a policy on service user rights and another on the temporary restriction of service user rights. There have been no vulnerable adult investigations or referrals made since the last inspection. A whistle blowing policy is in place. Staff have received vulnerable adult training. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 24,30 This judgement has been made using available evidence including a visit to this service. The service is homely and comfortable and meets the individual needs of service users. EVIDENCE: The home has been redecorated since the last inspection and new carpets have been fitted in the lounge and two of the bedrooms. A new carpet has been ordered for the third bedroom and is to be fitted in the next week. The décor has a calming affect and furniture and fittings complimented the overall style. Toilets and bathrooms provided private facilities and the home was clean and tidy with no mal odours. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Standards assessed, 32,34,35,36 This judgement has been made using available evidence including a visit to this service. There were adequate levels of staff within the home and interim management arrangements offer support and supervision of staff. EVIDENCE: Staff recruitment files were checked and these contained all of the necessary documentation and recruitment checks. Service users are supported by trained and competent staff. Staff have received fire safety training, first aid, food hygiene, communication and autism, makaton and the protection of vulnerable adults. According to the pre-inspection questionnaire there are four staff who hold NVQ level 2 or above making 50 of the total number of staff employed. There are six behavioural therapists employed by the organisation who can offer support and guidance to staff. The regional managers of the organisation stated that supervision of staff within such a small environment is ongoing and can be accommodated at short notice. It is recommended that these informal supervision sessions are recorded and a copy of the notes is kept on the staff members file. Staff Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 19 confirmed with the inspector that they are supervised. The interim manager visits the home three days per week and is in daily contact with staff. Please see recommendations section of this report. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 37,39,40,42 This judgement has been made using available evidence including a visit to this service. The current management arrangements are under review and interim arrangements are in place. There is a quality assurance procedure in place, which would benefit from feedback from external stakeholders. Health and safety policies and procedures are in place. EVIDENCE: The regional manager informed the inspectors that the provider is reviewing the current management arrangements of the home and that interim management arrangements have been put into place. The Commission for Social Care Inspection has been notified of the changes in writing. The interim manager spends three days per week at the home and is in daily contact with staff. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 21 It is recommended that the service seek the views of external stakeholders who are involved in the care of service users or are visitors to the home in order to include them in the process. According to the pre-inspection questionnaire all policies and procedures have been reviewed in July and August of this year. Health and safety policies and procedures are in place. Incident reports are kept in service users files. Fire equipment has been checked and evacuation drills are carried out monthly. The fire inspection carried out in 2004 was satisfactory. The fire safety service is due in December 2006. Insurance for the home is in place and valid until March 2007. PAT testing of electrical equipment was conducted in October 2006. A single company supplies COSHH cleaning products and safety data sheets are in place for each product. Please see recommendations section of this report. Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 YA20 Good Practice Recommendations It is recommended that the service review the practice of secondary dispensing of medication for planned and adhoc external activities, risk assess the practice and update any policies and procedures to reflect any changes made. It is recommended that informal supervision sessions with staff be recorded and a copy kept in the staff members file. It is recommended that the service seek the views of external stakeholders who are involved in the care of service users or are visitors to the home in order to include them in the process. 2. 3. YA36 YA39 Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. Extracts may not be used or reproduced without the express permission of CSCI Littlefield Gardens (2) DS0000013462.V321191.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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