Inspection on 07/02/07 for 2 Seymour Terrace

This inspection was carried out on 7th February 2007.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Seymour Terrace 28/01/09

2 Seymour Terrace 20/01/06

2 Seymour Terrace 06/10/05

2 Seymour Terrace 21/10/04

2 Seymour Terrace 14/09/04

2 Seymour Terrace 04/03/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 2 Seymour Terrace Totnes Devon TQ9 5AQ Lead Inspector Graham Thomas Unannounced Inspection 7th February 2007 09:30 2 Seymour Terrace DS0000003629.V323788.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 2 Seymour Terrace DS0000003629.V323788.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. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 2 Seymour Terrace Address Totnes Devon TQ9 5AQ 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) 01803 867506 enquiries@comae.org.uk Mr Simeon James Antony George Ramsden The Very Rev Archpriest Benedict Ramsden, Katherine H L Finnigan, Mrs Lilah Ramsden Mr Stephen Escott Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2006 Brief Description of the Service: The Community of St. Anthony and Elias specialises in the care and support of people with mental health needs. It has a number of homes in the Plymouth and South Hams areas of Devon. For ease of reference this is referred to as “the Community” throughout this report. Number 2 Seymour Terrace is close to the centre of Totnes where there is a range of shops as well as cultural and recreational amenities. Since the last inspection further changes have been made to the premises. The large lounge has been divided to create a smaller lounge and a third bedroom. The toilet on the lower ground floor has been extended to provide additional shower facilities. Service users are supported to maintain and develop their social contact, activities and interests. Individual programmes are supported by well developed arts and activities programmes run by the Community Fees for a place at the home currently range from £1,800 to £2,300 per week. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the Inspection, the Registered Manager completed a pre inspection questionnaire. The home was visited by the Inspector who spent six hours on the premises. During this time he attended a staff handover meeting and interviewed one of the two service users currently living at the home. Three staff were also individually interviewed. Care plans, staff files and other records were examined. The Inspector toured the building and inspected all rooms except one service user’s bedroom. Discussions were held with the Registered Manager and the Community’s Human Resources Officer. What the service does well: What has improved since the last inspection? A new bedroom has been created in the home since the last inspection and there is a new shower room. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. 2 Seymour Terrace DS0000003629.V323788.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 2 Seymour Terrace DS0000003629.V323788.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): 2 Quality in this outcome area is good. Prospective service users can feel confident that their needs and aspirations will be known and understood before they move in to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection, two service users were living at the home. Professional assessments were contained on both care plan files and the Community’s own assessments were also seen. These included the interests and aspirations of each service user. Care plans with clear goals were in place for both service users. Risk management plans had been formulated on the basis of individual assessments of risk. These clearly identified actual and potential restrictions on freedoms and choices. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. Service users are very well supported to make choices about their lives and pursue their individual goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both care plans were examined. The plans were very well organised and showed clearly how individual goals and needs were being pursued and met. They had been regularly reviewed and were signed by service users. Each plan set out detailed goals regarding the physical emotional and social needs of the individual. There was a clear and well-defined cycle of assessment, planning action and review in the plans and daily records. Within the plans there were comprehensive risk assessments and risk management plans. Documents were seen in the files relating to specialist mental health support. Reviews had taken place under the Care Programme Approach. The plans had been regularly reviewed within the Community. Details of restrictions on usual freedoms were recorded with the reasons for such restrictions. In the handover meeting attended by the Inspector, staff showed an awareness of the contents of the plans to which they were evidently adhering. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 10 Discussion with one service user showed that his plan was an accurate reflection of his individual needs and aspirations. For example, the plan contained correspondence relating to future housing and employment plans which were also discussed with the service user. The choices available to service users were evident from care plans and discussion at the staff handover. Both service users enjoyed a high degree of independence and had made many choices about employment, social activity and the development of their skills and interests. In discussion, one service user confirmed that he was very satisfied with the guidance and support offered by staff. This included practical supports such as providing transport when necessary. This discussion and evidence from both plans demonstrated a thoughtful and active approach to supporting service users and meeting their individual needs. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17 Quality in this outcome area is excellent. Service users are very well supported to become more independent. Their individual lifestyle choices and aspirations are appropriately respected and supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, the service users at Seymour Terrace were enjoying a high degree of independence. Lifestyle issues were discussed with one service user, staff and the Registered Manager. These issues were also examined in both care plans. Both service users had access to the Community’s commendable activities programme which includes arts and outdoor activities. Individual activities and ambitions were also being well supported. For example, one service user had undertaken a computer course and a course in Shiatsu massage. Both had been supported to pursue their employment ambitions through voluntary work. This had been enabled through the use of an external employment agency. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 12 Encouragement and support had been provided to socialise in the wider Community. One service user felt that he had received very good support to develop the social skills needed for a more independent lifestyle. This included developing confidence in everyday social situations such as visiting cafes. The development of these skills was reflected in the goals described in his individual plan. Assertiveness training was being organised for one service user. Daily records and individual plans showed how relationships with family and friends were being very well supported. This included family visits and telephone contact. In discussion, one service user describe how the staff had offered supportive advice regarding a relationship difficulty. The rights and responsibilities of service users were clearly respected by staff. Each service user had a key to their room. Individual plans demonstrated how the independence of each service user had been promoted within the framework of clear risk management plans. Given the level of independence of both service users, staff support was being offered on a flexible basis. One service user commented “they let me think about things” and “they’re always there for me”. Mealtime arrangements in the home reflected the level of independence of service users. Food is purchased on a shift by shift basis following consultation with service users. One service user followed a vegetarian diet. The other was being supported and encouraged to follow dietary advice arising from a medical condition. Records were kept of meals taken in the home with space for the Registered Manager to review and comment upon the menu. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. The support and healthcare provided to service users is generally of good quality. However, the arrangements for administering medicines are not adequately clear. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both service users living at Seymour Terrace at the time of this visit enjoyed a high degree of independence. Personal support therefore took the form of emotional and social support, advice and guidance. This was well described in individual plans. One service user commented positively on the support received in the development of social skills and in managing relationships (see “Lifestyle” above). In addition to the support available in the home, the Community has a consultant Psychiatrist. Individual plans also showed how external mental health workers and other agencies (e.g. with regard to employment) were deployed to support service users. The Inspector attended a staff handover meeting. Individual service users’ needs were discussed including ongoing health issues. Care plans contained records and correspondence relating to both routine and specialist medical appointments. During the inspection, one service user was supported to attend a medical appointment. In discussion, one service user described how staff 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 14 were supporting him to adhere to a diet and exercise regime which had been medically advised. The arrangements for administering medicines were examined. Medicines were securely stored in the home’s office. Since the last inspection additional secure storage for controlled drugs had been fitted. One controlled drug was in use and this was recorded in a controlled drugs register. Medicines received from the pharmacy were signed for by the Registered Manager. There was also a record of those medicines returned. Patient information leaflets were held for the medicines in use. An error by the supplying pharmacy was detected by staff and discussed at the handover meeting attended by the Inspector. The Registered Manager stated that service users were being encouraged to take responsibility for their own medication as part of the process of becoming independent. At this stage, the medication was stored in the office. However, service users administered their own medication under observation and then signed the medicines administration record themselves. This included “as required” medicines. There were no risk assessments in place concerning selfmedication. It was not clear whose responsibility it was to record, for example, when or why medication was not taken. To ensure that this system is clear for staff and safe for service users it is required that the system in use should be clearly described in a risk management plan for each individual. This plan should address issues such as responsibilities for recording and the administration of PRN (“as required”) medication. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Service users can feel assured that their views and concerns will be listened to and acted upon. There are sufficiently robust systems in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints had been made to the home or Commission at the time of inspection. A complaints procedure was in place which had been made available to service users. This included details of how to complain directly to the Commission. The size of the home and degree of individual attention enable individual concerns to be dealt with informally before they might escalate. This was confirmed in discussion with one service user. One minor complaint had been recorded by the home. The record showed that this matter had been satisfactorily resolved. Policies and procedures were in place concerning the protection of vulnerable adults from abuse and whistle blowing by staff. The training programme discussed with staff included elements of understanding and managing aggression. All staff were trained in de-escalation techniques as well as physical intervention. The Community’s Finance Officer has stated that all service users’ monies are held independently of the Community’s business accounts. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good Service users live in a sufficiently clean, comfortable, homely and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 Seymour Terrace is located close to the Centre of Totnes and all local amenities and transport links. Although the home is registered for three places, there were only two usable bedrooms at the last inspection. Since then the lounge has been divided to provide a smaller lounge and a third bedroom. A new shower room has also been added in a small extension to the lower ground floor. Service users’ accommodation was arranged over three floors. On the lower ground floor there was an office, a kitchen / dining room, laundry and the new shower room and toilet. Staff sleeping accommodation was provided in the office. On the ground floor there was a bathroom, a lounge and one service users’ room. The first floor comprised two service users’ rooms and a staff sleep-in room. A second floor is not suitable for service users’ use and was being used for storage. 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 17 On inspection, all areas were adequately clean, well decorated and comfortably furnished. At the time of the inspection visit the Community’s maintenance person was repairing and redecorating the bathroom door. The new bedroom was awaiting the fitting of a hand basin before it was to be occupied. There were no obvious hazards. Potentially hazardous substances were kept in locked storage. Maintenance and safety records showed, for example, regular checks of water temperature, tests of portable electrical appliances and recent legionella testing. The laundry facilities were of a domestic scale in keeping with the size of the home and the needs of its residents. These were separate from the kitchen facilities with cleanable walls and washable floors. 2 Seymour Terrace DS0000003629.V323788.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): 32, 34 and 35 Quality in this outcome area is good Service users are supported by well-trained staff who hold positive attitudes about their work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed at a handover meeting and interacting with service users. Three staff were individually interviewed. There was also some group discussion with staff. Individual staff files were examined which included training and supervision records. Staff displayed positive attitudes towards service users when going about their work. This was evident in the staff handover meeting, interactions with service users and in the style and content of the records examined. The needs and aspirations of individual service users were understood and respected. More recently recruited staff discussed training with the Inspector. This includes a comprehensive induction training programme for new recruits. A full week’s training is usually provided before the new recruit commences duty. This is followed by eight to ten weeks training for one day per week. Health and safety topics are included in this programme as well as issues specific to the needs of the service user group. The Community’s Human Resources 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 19 Officer attended during the inspection. She brought evidence that the Community had won a South West Training Award for its induction training. At the time of inspection, 75 of the staff group held a National Vocational Qualification in care at level 2 or above. During this inspection, notes were seen concerning proposed further developments in the staff training programme including autism and Aspergers syndrome and acquired brain injury. Examination of staff files and discussion with staff revealed a sound recruitment process. This process included a visit to the home, a formal application, references, criminal records checks and a formal interview. Staff confirmed that they received statements of terms and conditions and that their appointments were subject to a probationary period. The Community’s Human Resources Officer stated that all staff whose criminal record checks were over three years old were being re-checked, though this is not currently a requirement. Staff training is managed at a corporate level. However, each staff member has an individual training profile and evidence was seen of ongoing training. This included update training in topics such as first aid. 2 Seymour Terrace DS0000003629.V323788.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): 37, 39 and 42 Quality in this outcome area is good The service is well managed for the benefit of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager of 2 Seymour Terrace is experienced and qualified to NVQ level 4 in Care. He has also completed the Registered Managers Award. Evidence from this inspection including discussion with a service user and staff indicated that the home was well run. This was further confirmed by the ongoing maintenance seen during the inspection and the recent development of the premises. The above indicators together with examination of the care planning documents suggest that the home is well run for the benefit of service users. A system for monitoring and developing the quality of the service was undergoing further development at the time of this inspection visit. Feedback questionnaires were being sent to service users, relatives and external professionals. It was envisaged that these would be sent in two batches each year. The quality of care planning, maintenance and lifestyle issues 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 21 demonstrated that effective quality monitoring systems were in place with good outcomes for service users. Health and safety issues in the home were examined. Records and discussion with staff confirmed that health and safety topics such as first aid and fire safety were covered in the staff training programme. Records of health and safety checks were seen which were up to date and in good order. Examples included gas safety checks, the testing of portable electrical appliances and legionella testing. Fire safety records showed regular testing of fire alarms and equipment as well as regular fire drills. Hazardous substances were kept in a locked cupboard and their location recorded. Risk assessments and management plans were in place for environmental risks. All the upper floor windows had restricted opening to prevent falls. 2 Seymour Terrace DS0000003629.V323788.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 X 2 3 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 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 x 3 X 2 X X 3 X 2 Seymour Terrace DS0000003629.V323788.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. 1. Standard YA20 Regulation 13(2) Requirement The Registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In particular, there must be clear guidelines in place within a risk management framework for service users who administer their own medication independently or semiindependently. Timescale for action 15/03/07 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 2 Seymour Terrace DS0000003629.V323788.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 2 Seymour Terrace DS0000003629.V323788.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. Re-publishing this information is in breach of the terms of use of that website. 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