Inspection on 02/08/05 for 2, Saxon Close

This inspection was carried out on 2nd August 2005.

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, Saxon Close 27/02/09

2, Saxon Close 28/03/07

2, Saxon Close 11/01/06

2, Saxon Close 27/01/05

2, Saxon Close 06/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 2 Saxon Close 2 Saxon Close Flitwick Bedfordshire MK45 1UT Lead Inspector Ansuya Chudasama Announced 2 August 2005 nd 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. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 2 Saxon Close Address 2 Saxon Close Flitwick Bedfordshire MK45 1UT 01525 720170 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) MacIntyre Care Mrs Elaine L Holliman CRH Care Home 6 Category(ies) of PC Care Home only registration, with number of places 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27.1.05 Brief Description of the Service: 2, Saxon Close, residential care home provides long-term care to six people with learning disabilities. The home was purpose built in 1998. MacIntyre care, which is a voluntary organisation, operates the home. The accommodation consists of five single bedrooms, two bathrooms, and one separate toilet on the first floor. The ground floor has a bedroom with en-suite facilities, one separate toilet, a small quiet room, and a large lounge. An office combined with staff sleeping in room is also situated on the ground floor. A new conservatory was installed for service users who smoked. The home has a large rear garden with a summerhouse. The home is within walking distance of the town centre and its shops. There is easy access to buses and trains. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Announced inspection took place over 6 hours. The manager Mrs Elaine Holliman was present at the inspection. The inspection comprised of a tour of the bedrooms, bathing facilities and the communal areas of the home, care tracking in relation to two service users and conversations with all the service users, staff and the manager. There were five service users in the home. One service user was having an assessment at a rehabilitation unit. What the service does well: What has improved since the last inspection? The requirements from the last inspection had been met. The manager stated that the hallway and bathrooms had been painted. A new table in the kitchen, 3 beds and one new wardrobe and a new leather sofa in the quiet room had been purchased. The fire equipment was updated and new emergency lights were installed. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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) 1,2,3,4,5. The homes statement of purpose and service user’ guide provided prospective service users and their families information of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: The home had a statement of purpose and a service users’ guide. This contained clear information about the home and the services and support that was offered to service users. Clear information about the staff’s qualifications and experience was also included. Information on how to complain was also available. The home had not admitted any new service users for a number of years. Most of the service users in the home had lived together for over 20 years in previous MacIntyre homes. Five service users had all moved into this home together when it first opened. One service user had moved in four years ago. It was stated that all service users had assessments undertaken and the funding agency and relatives were involved when service users moved into the home. All service users had visited the home prior to moving in permanently. The home had a service users’ written agreement and a document called “what’s in your licence agreement”. The manager and the service users’ key worker had signed the agreement. It is good practice to get the service user’s family or their representative to sign the document if the service user is unable to understand the information. This is seen as promoting the rights of service users. The document also needed reviewing as the information referred to the service users stay at the home being on a trial basis. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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) 6,7,8,9,10 There was clear and consistent care planning systems in place to provide the staff with the information they needed to meet the needs of the service users to a high standard. EVIDENCE: Two service users’ files inspected had very detailed information on how service users needs were being met by staff. The plans covered information on personal, social and healthcare needs. Some of the information needed putting in the right section and this was done on the same day. The key workers of the service users reviewed the plans on a regular basis. Every one that was involved in discussing them also signed the plans. It was good to see service users who were not able to write their name, were encouraged and helped by staff to make their own mark to make them feel part of this process. The home had person centred planning (PCP) on individual service users. The information seen was in pictorial format that the service users were able to identify with. The staff spoken to gave many examples of how they helped service users to make decisions about their lives. It was stated that they used the method of communication that the service users understood and this was recorded in 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 10 their care plans. For example they used pictures, simple verbal language, service users body language facial expression and information from families to help them make decisions. Detailed information was available on service users risk assessments. These were monitored by management and reviewed by staff. Staff understood information on confidentiality and they undertook this in their induction training. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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) 11,12,13,14,15,16,17. Service users have opportunities for personal development to enrich their social and educational opportunities. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: Service users attended the organisations learning services four days a week and they had a day back at the home to work to on their personal development on a one to one with staff. This was observed on the day of the inspection. Service users participated in house meetings. The home encouraged service users to sign for their money and staff accompanied them to the bank. One service user in the home had attended staff meetings, when confidential information was not being discussed. Service users helped make sandwiches to take to the day centre with support from staff. All the service users helped with house keeping chores in the home. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 12 The in-house activities for service users included having a foot spa, beauty sessions, gardening, baking, art and craft, watching videos, and helping staff with the barbeque. Some of the service users attended church. They also went out on day trips to the garden centre, seaside, safari parks, museums, and social clubs. The service users used public transport, and the home’s vehicle to access these activities. All the service users also went on holiday. They chose the holidays and activities. Photographs of places that the service users had been to were displayed in the house. All the service users in the home had families and staff encouraged their involvement by writing to them and speaking to them on the phone. The staff also accompanied service users to visit their families. The home had rules and routines to meet service users daily needs. These were discussed and agreed by them. The manager stated that these were also flexible to meet the needs of the service users. Service users were able to keep pets in the home with the permission from the manager. All the service users were offered keys to their bedrooms, however two accepted to hold keys and the others declined the offer. Service users choose the meals in their weekly meetings. They were given pictures to choose the meals for the week. The menu seen was in pictures and was varied and nutritious. They also helped staff with shopping and with meal preparation. Service users, who were diabetic, had their dietary needs met by having sugar free drinks and a healthy diet. Service users spoken to liked the meals. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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) 18,19,20,21. The knowledge of staff, safe systems for administering medication and detailed care planning meant that the health needs of service users are met. EVIDENCE: The care plans seen had detailed information recorded about how the staff were meeting service users’ personal care needs. Guidelines were also written about service users routines to ensure that this was maintained and continuity was provided. The staff spoken to had very good understanding about the service users needs and gave many examples of how this was carried out. Service users were appropriately dressed and records showed that they went shopping with staff and picked their own clothes. Detailed information was recorded in the care plans to explain how service users’ health care needs were being met. Appointments to health care professional and the outcome of the visit were well recorded. Weight charts were also maintained. Information on medication and reviews undertaken was recorded. All staff who gave out medication had received the accredited training on medication. Information on service users’ burial arrangements was seen. Specialist services from Twinwoods Learning Disability Resource Centre were accessed by the home. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 standard(s) 22,23. The staff have good knowledge and understanding of adult protection issues, which protect service users from abuse EVIDENCE: The home had a complaints procedure, and this information was available in the service users’ guide. The organisations complaints policy needed reviewing to include all the information stated in the standard. Service users’ files seen had information recorded about how they communicated verbally and nonverbally to show when they were unhappy. The staff spoken to understood this information very well, and, gave examples when this had happened. There was information also recorded to state what made service users vulnerable, and reduction methods were also put in place to minimise this risk. The home had policies and procedures on Adult Protection and the MultiAgency Protocol on protection of vulnerable adults (POVA). The manager undertook teaching sessions on this subject to all the staff in the home and externally. Some of the staff had also attended training on POVA that was provided by social services. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 standard(s) 24,25,26,27,28,30. The premises were well maintained so as to allow all those living at the home to enjoy a homely and comfortable environment that was safe, clean, and hygienic. EVIDENCE: The homes premises were homely and met the needs of the service users. The premises were clean and all service users were observed accessing all parts of the home. The bedrooms seen were individualised and had ornaments and pictures that the service users had bought with support from staff. Service users spoken to stated that they liked their rooms. The décor throughout the home was in good condition and furnishings were domestic and of a good standard. The manager stated that the hallway and bathrooms had been painted. A new table in the kitchen, 3 beds and one new wardrobe and a new leather sofa in the quiet room were purchased. The home had a beautiful garden with a summerhouse, a swing, shed and a gazebo. In the summer months the home had barbeques and evidence showed that the garden was well used by the service users and staff. One of the service users informed the inspector that he enjoyed gardening, and he was very proud to show his green 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 16 house, where he grew his vegetables. He also stated that he “likes it here”. One of the service users in the home smoked, and he was able to smoke in the conservatory or in the garden. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36. The home provided very good training so that the people living at the home had their needs met by competent and suitable staff. EVIDENCE: The inspector was informed that the home had been short of staff but it was now fully staffed. The new member of staff spoken to stated that she had received a good induction and this was linked to NVQ training. All the staff spoken to had completed the mandatory and other relevant training in specialist areas to meet the needs of the service users. Four staff were undertaking NVQ level 2/3 training. The staff spoken to had link worker meetings with their seniors on a monthly basis to discuss service users aims and objectives. They also received monthly supervision and stated that this was good. Staff meetings were also carried out regularly and these were found to be very good. It was stated that the manager had developed a few policies, as the organisations policies did not meet the standard. The staff recruitment files had the relevant information required. However it was noted that one reference was taken over a phone but all the information was not recorded. The manager stated that she would ensure that all the information was recorded and two copies of references were obtained. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 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) 37,38,41,42 The home has an experienced and committed manager who ensures strong leadership, and safe working practices so that service users health, welfare and safety are safeguarded. EVIDENCE: The manager had over twenty five years experience of working with the service user group. She was undertaking her training in NVQ level 4 in management. She ensures that she keeps her own training up to date and is committed to achieving and maintaining high standards within the home. The manager takes on the responsibility of training of all senior staff in the homes. The staff spoken to stated that the manager communicated a clear sense of direction and involved them in what was happening in the home. It was also stated that she was very supportive and encouraged staff to discuss ideas. All staff spoken to stated that they worked well as a team and most of them had worked at the home for many years. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 19 The staff had training on fire safety. Service users were involved in fire drills and this was discussed in their meetings and on a one to one basis. The fire equipment was updated and new emergency lights were installed. Risk assessments were undertaken for the environment. . The home had annual audits on health and safety carried out by the organisation. 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 3 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 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 4 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 2 Saxon Close Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 4 x x 3 3 x I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 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 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 Good Practice Recommendations 2 Saxon Close I51 S14964 2 Saxon Close V231579 020805 stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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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