Inspection on 26/04/07 for 20 Towngate East

This inspection was carried out on 26th April 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

20 Towngate East 27/04/06

20 Towngate East 03/11/05

20 Towngate East 17/06/05

20 Towngate East 02/12/04

20 Towngate East 23/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 20 Towngate East Market Deeping Lincolnshire PE6 8DR Lead Inspector Mr David Bacon Unannounced Inspection 26th April 2007 08:00 20 Towngate East DS0000002309.V337240.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 20 Towngate East DS0000002309.V337240.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. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 20 Towngate East Address Market Deeping Lincolnshire PE6 8DR 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) 01778 342091 jodawson75@msn.com http/www.milburycare.com/home.html Milbury Care Services Limited Miss Joanne Lesley Dawson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Learning Disability (LD) - 7 places The maximum number of service users to be accommodated is 7. Date of last inspection 27th April 2006 Brief Description of the Service: 20 Towngate East is situated in the market town of Market Deeping in South Lincolnshire and within easy reach of local services and facilities. The home is registered to provide residential care for 7 adults having a learning disability. All bedrooms in the home are single and are situated on the ground and first floors. One bedroom has an en-suite facility. To the rear of the property there is a large lawned garden, which is easily accessed by service users. There is no garden to the front of the property. The home has one main lounge area and a separate dining room. The range of fees is between £779.90 and £1’230 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over four hours; it was unannounced and was carried out by one inspector. The care received by two residents was looked at in detail. This process is called “case tracking” and individual residents care records and general home records were looked at as part of this along with observations of staff/resident interaction. Discussions with resident’s representatives was held to seek their views regarding the standards of care provided. The inspector spoke with three residents’ representatives, the registered manager and two staff members. A District Nursing sister was spoken with regarding the standards of healthcare provided within the home. Information already held by the commission was also used as part of the inspection process. A tour of the premises was conducted, service users care records and staff records were inspected along with policies/procedures and administrative systems. What the service does well: What has improved since the last inspection? What they could do better: 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 6 An insufficient number of waking night staff were on occasion being deployed to fully meet residents current care needs and to minimise risks although the home took action regarding this matter during the visit. Care records were not all reviewed or updated regularly as residents care needs or personal circumstances altered and did not document resident’s regular involvement in this process. The homes systems for supporting residents and their representatives to express their views and improve the services provided were not being utilised. 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. 20 Towngate East DS0000002309.V337240.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 20 Towngate East DS0000002309.V337240.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 This judgement has been made using available evidence including a visit to this service. There are satisfactory procedures for assessing and introducing new residents to the home. EVIDENCE: The care records seen evidenced that a detailed care assessment had been undertaken of residents care needs, which involved relevant supporting health professionals and representatives. The manager said that this is undertaken prior to the resident’s admission to the home, where possible. The care plans clearly identified specific care and health needs as well as providing a comprehensive insight as to preferred lifestyles, likes and dislikes. Information regarding any specific behavioural needs was included along with guidance from relevant health professionals and instruction for staff. A separate plan is completed of which residents are involved utilising a pictorial or other appropriate format. The representatives spoken with were satisfied with the homes admission procedures and confirmed that they were given relevant information about the services provided by the home. 20 Towngate East DS0000002309.V337240.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, 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a person centred approach, which enables them to develop their independence in a safe and supported manner although care records are not adequately reviewed or updated to reflect individuals changing needs. EVIDENCE: The care records viewed clearly identified the individual care needs of residents and how these were to be met along with any goals, preferred routines, aims, objectives, identified risks and how these were to be minimised. The care records seen were not being updated to document that residents care needs were being regularly reviewed and updated and did not document residents involvement in this process. For example, regarding resident’s family circumstances and some behaviour issues. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 10 Policies and procedures promoting and safeguarding residents rights, confidentiality and data protection is in place within residents care records and providing guidance to staff. The staff members spoken with were aware of residents care needs and how to promote residents rights, dignity and choices of which awareness training is provided. The residents representatives spoken with said that residents are treated with respect and supported to make decisions regarding their day to day lives where this is possible, which was further evidenced within the care records and completed satisfaction surveys seen. Comments included: “Well, I think they are all treated well, my loved one would let me know if not”. “I think they all seem to be treated well and looked after very well”. “Yes, you can see the care is good”. 20 Towngate East DS0000002309.V337240.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 good This judgement has been made using available evidence including a visit to this service. Resident’s rights are respected and they are supported to follow their chosen lifestyle within the community and to develop any life skills or interests. Resident’s users enjoy the homes provision of meals. EVIDENCE: Residents are supported to maintain and develop any skills or interests, which is included within their care plans and was further confirmed by the representatives spoken with. Any specific goals are included and communications with relevant supporting agencies are noted. Comments from representatives included: “My loved one gets involved in all sorts of activities”. “There are a variety of things they do but perhaps not so many at weekends if there are not enough staff”. “I know the activities and outings are very much enjoyed”. The comments received were discussed with the home manager 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 12 who agreed to improve systems to further enable resident’s representatives to express their views about the services provided. Residents are notified of their rights in formats that are user friendly where possible and care records clearly instruct staff as to how individual rights and choices are to be promoted and met. Information relating to sexuality and relationships is included and policies and procedures are in place regarding this subject matter providing guidance to staff. The majority of residents attend day centres and college during the week where this is appropriate. The home has a vehicle to give residents access to the community and public transport is also utilised. Residents are able to attend a variety of clubs and leisure facilities and holidays are also available. Pictorial records of events and activities are maintained along with a monthly chart of activities undertaken. Resident’s dietary needs are noted and a new system for recording all meals taken is in place for each resident. Residents are involved in choosing the foods provided. The resident’s service users representatives spoken with were satisfied overall with the homes provision of meals although some suggestions were made. Comments included: “The food seems good but I’m not sure if all the staff can cook properly”. “I know my loved one enjoys the meals but I’m not sure what is provided”. “Oh yes, there is a choice and plenty of food”. It is recommended that systems are put in place to further enable resident’s representatives to express their views regarding the homes provision of meals. Information regarding resident’s food preferences and any dietary requirements are clearly documented in individual care plans. 20 Towngate East DS0000002309.V337240.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, 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The current nighttime health care needs of residents are not all consistently met, although overall there is good liaison with healthcare services. Residents wishes regarding the care they receive is promoted. EVIDENCE: Residents are supported to administer their own medicines if they are assessed as able. Policies and procedures regarding the administration of medicines provide guidance to staff whom receive awareness training regarding this subject matter. A new medication storage facility is in place and administration records are satisfactory. Care records instruct staff as to individual residents care needs and preferences and service users are involved in the devising and updating of their own plans where this is possible, which was further evidenced by the representatives with whom the inspector spoke. Individual preferences or instructions regarding bereavement are documented. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 14 Residents health and medical needs and input were clearly identified within the care plans seen although these had not been fully updated to accurately document the night time care needs of two residents, including risks. For example, one residents care needs had increased following them fracturing their arm and another needed increased care following some changes to their medication. The Registered manager took some action to address this during the visit. The District Nurse spoken with was satisfied with the care provided and that the homes staff followed any given instruction or advice. 20 Towngate East DS0000002309.V337240.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, 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Systems are in place for residents to raise concerns or complaints and the home has provided some training and support for staff to make sure they are able to act in order to protect the residents from the risk of abuse or harm. EVIDENCE: There have been no formal complaints or safeguarding adult referrals since the last inspection. The resident’s representatives with whom the inspector spoke said they felt able to express any views to staff and that they would be appropriately acted upon. Comments included: “Well I would just say if I had any problems”. “You can speak with the staff, the manager or area manager”. “The staff are approachable, yes I can talk with them”. Residents are notified as to how to make a formal complaint in appropriate formats and pictorial information regarding this subject matter is displayed in the home. Advocacy information is also made available and the registered manager said that these would be contacted as necessary. Risk assessments are in place specific to residents care needs. Staff have received some training on how to safeguard vulnerable adults from abuse and further training is now planned for newly recruited staff. 20 Towngate East DS0000002309.V337240.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, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The standard of the physical environment is good and provides residents with a comfortable and homely place to stay. EVIDENCE: The home was clean and tidy and odour free throughout. The resident’s representatives spoken with said that the environment was homely and comfortable and that service users are supported to personalise their own accommodation, which was further evidenced during a tour of the building. Risk assessments of the premises are undertaken and any required action is taken as necessary. Staff receive awareness training regarding health and safety and cleaning materials are safely stored, which was further confirmed by the staff members spoken with. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff have the skills and experience necessary to carry out their roles although adequate numbers of staff must be deployed at all times to appropriately meet service users care needs. EVIDENCE: The staff files inspected evidenced that appropriate recruitment policies and procedures are undertaken prior to staff commencing work at the home. Newly recruited staff attend induction training upon commencing work at the home of which records are maintained. The staff members spoken with were satisfied with the recruitment process and confirmed that they had received induction and training appropriate for the roles. A training plan is in place and any outstanding training needs are identified and provided for. The residents representatives spoken with said that they were satisfied overall with standards of care overall but that the home was not always well staffed at weekends. Also, it was established during the visit that the night staffing 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 18 arrangements had not recently been fully adequate to meet the current care needs of two residents, which was further evidenced through viewing the homes staffing rota. The Registered manager and area manager took action to address this during the visit. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s rights are promoted and safeguarded. Some systems are in place to measure the quality and satisfaction levels of the services provided although these are not fully adequate. The health and safety of the home is adequately maintained. EVIDENCE: The resident’s representatives and staff spoken with were satisfied with the management of the home. Comments included: “Yes, it seems generally to be managed okay”. “If you need to you can talk with the staff, the care seems good”. Policies and procedures safeguarding resident’s rights are in place and staff receive guidance regarding these, some of which have been updated. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 20 Residents meetings are not regularly held and although quality satisfaction questionnaires have been devised, these are not regularly used. The representatives spoken with as part of this site visit all indicated that their views were not fully sought regarding life within the home. The manager agreed to address this. Systems are in place to promote health and safety within the home following comprehensive risk assessments being undertaken and staff attend awareness training regarding this subject matter. 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 21 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 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 2 X X 3 X 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 22 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 YA6 Regulation 15 (1) Requirement Timescale for action 01/06/07 2 YA33 18 (1) (a) 3 YA39 24 Care records must accurately document each residents care needs, be regularly reviewed and updated as needs change and must involve residents where possible. Sufficient numbers of waking 01/06/07 night staff must be deployed to appropriately meet the care needs of service users. A system for reviewing and 01/06/07 improving the quality of care provided must be in place which service users and their representatives are involved where possible 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 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 20 Towngate East DS0000002309.V337240.R01.S.doc Version 5.2 Page 24 - 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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