CARE HOME ADULTS 18-65
201a Berrow Road Burnham-on-Sea Somerset TA8 2JF Lead Inspector
Jane Poole Announced 23 August 2005 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. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 201a Berrow Road Address Burnham-on-Sea Somerset TA8 2JF 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) 01278 786358 Mrs Veronica Margaret Hawkins Mrs Veroncia Margaret Hawkins Personal Care Home only 3 Category(ies) of Learning Disability (3) registration, with number of places 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 30 March 2005 Brief Description of the Service: 201a Berrow Road is registered to provide personal care for up to 3 people with learning difficulties. The home is owned by Mr and Mrs Hawkins and is managed by Mrs V Hawkins. Both owners live at the home and provide all care, no staff are employed. The house itself is a spacious family style home set in attractive gardens. It is within easy reach of Burnham town centre and the sea front. All bedrooms are located on the first floor meaning that service users need to be physically able. All bedrooms are for single occupancy and bathroom facilities are shared. There are currently two service users who live permanently at the home. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. 201a Berrow Road is a domestic house, which currently offers family style living for two service users. This inspection was carried out over a 1.5 hour period. The time was spent talking with the owners, viewing records kept, viewing the premises and private discussion with the service user who was at home during the inspection. What the service does well: What has improved since the last inspection?
At the time of the last inspection concerns had been raised about the behaviour of one service user and requirements were made in respect of a more detailed care plan, risk assessments and agreement of any restrictions imposed upon the service user.
201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 6 Since this time a full review has been carried out with the service user and their care manager and the care plan has been up dated. A recommendation of the review was for a community access worker to be made available who will assist with finding suitable work placements. This is now in place. On discussion it appeared that the owners feel much more supported and have another channel for guidance and advice. The owners continue to refurbish areas of the house to ensure that it is maintained to a high standard. 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. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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 & 5 (No new service users have moved to the home since the last inspection therefore the majority of these standards have not been assessed.) Each service user has a financial agreement with the Local Authority. The Service User Guide states what is included in the basic fee. EVIDENCE: The home has produced a brief Statement of Purpose and Service User Guide, which is appropriate to the size and nature of the home. There have been no changes to these since the last inspection. The Local Authority financially supports both service users living at the home. Each person has a financial agreement with the relevant Social Services Department. Copies of these were seen in individual files. Fees charged are dependant on the needs of the individual. The Service User Guide gives details of what is included in the basic fee; it does not include personal items and services such as toiletries and hairdressing. No new service users have moved to the home since the last inspection. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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. Individual care plans give information about needs, likes and dislikes and are appropriate to the size and nature of the home. EVIDENCE: No staff are employed at the home and all care is carried out by the manager and her husband. Both are extremely familiar with the needs of the service users. Each person has a care plan, which gives basic details of the needs of the service user and includes their likes and dislikes. Since the last inspection the care plans have been made more comprehensive in respect of behaviour and any limitations on movement. One care plan seen also contained a weekly timetable of activities undertaken. Both care plans had been fully reviewed since the last inspection and there was evidence that alterations are made when circumstances change. Daily records are kept for each service user. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 10 The service user at home during the inspection had a copy of their care plan in their personal room. The home operates as a family type unit with everyone sharing decision making where appropriate. The inspector observed that the service user moved freely around the house and garden and appeared very comfortable in their surroundings. Service users are involved in shopping, family social occasions and are able to assist with household tasks if they choose to. At the previous inspection concerns were expressed about the behaviour of one service user who accessed the local community without assistance. A requirement was made that a risk assessment was carried out. This has now been fully discussed with the service user and their care manager and measures are in place to minimise risk. The manager has recently undertaken a health and safety course, which included the use of risk assessments. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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) 12, 13, 14, 15, 16 & 17. There are ample opportunities for service users to access the local community and the owners encourage the use of community amenities and facilities. The home enables service users to maintain links with family by assisting with communication and providing transport. EVIDENCE: There are no set menus in the home; all meals are cooked in accordance with known likes and dislikes. The main meal is in the evening when all members of the household are at home. Service users are able to choose where they eat their meals. On the ground floor there is a kitchen that is shared by all members of the household and the inspector saw that the service user was able to use the kitchen to make drinks at any time. Service users have opportunities to take part in leisure activities. The home operates in a family style and outings are arranged in line with this.
201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 12 Service users go out for meals, to a local club and shopping. The home has been extremely pro-active in assisting service users to take part in activities outside the home. One person has joined a local bell-ringing group and attends a social club twice a week. In addition to activities outside the home service users have access to TVs, videos and games. The inspector observed that service users are free to choose how they spend their time and are free to access their rooms and communal areas at anytime. There are no set routines. In line with the recommendations of a review meeting, one of the service users now has an access worker two days a week. It is hoped that this worker will assist the service user to undertake part time work. Service users are encouraged to maintain contact with family and friends. The owners assist people to maintain contact by telephone calls and visits. One of the service users regularly goes to stay with family for weekends and the home provide transport for a service user to visit an elderly relative. At the time of this inspection one service user was on holiday with a family member. The other told the inspector that they were going to stay with family next month. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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. Service users are encouraged to be independent with personal care but support and prompting are given where appropriate. Service users have access to a range of healthcare professionals and are able to discuss issues in private. EVIDENCE: The service users share a pleasant bathroom on the first floor where personal care is carried out in private. Care plans seen showed the level of support each service user requires with personal care. People are encouraged to be as independent as they are able and supervision and prompting are offered where appropriate. The service user spoken to stated that they were happy with the assistance given with personal care. Each person is registered with a local GP and accesses other healthcare professionals, such as dentists, opticians and psychologist, as required. Records are kept of any medical visits. These records show that one of the service users usually visits the GP alone whilst the home supports the other person to attend appointments.
201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 14 A GP who completed a comment card prior to this inspection stated that they were always able to see their patient in private. One service user takes regular medication, which is administered by the manager. All medication is kept in a locked cupboard and Medication Administration Records are kept, these records were seen by the inspector and found to be correctly signed when received and administered. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23. Service users are able to raise any worries or concerns with the owners, family or professionals outside the home. EVIDENCE: As previously mentioned the home operates a family style environment, which allows service users to raise any worries or concerns with the owners. Both service users have regular access to professionals and family outside the home if for any reason they felt unable to discuss an issue with the owners. The service user spoken to stated that if they were unhappy they would tell the manager. There is a copy of the Somerset County Council “Safeguarding Vulnerable Adults” policy and a formal complaints policy. The inspector observed that the service user had unrestricted access to all communal areas of the home and appeared extremely comfortable in their surroundings. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28 & 30. 201a Berrow Road provides comfortable family type accommodation for people who are physically independent. EVIDENCE: 201a Berrow Road is a domestic dwelling that provides comfortable accommodation within a family type environment. It is located in Burnham on Sea, close to the sea and public transport links. All bedrooms are for single occupancy and are located on the first floor, meaning that service users need to be physically mobile. The owners of the home live at the house and have some private accommodation. There is a lounge for the exclusive use of service users and all members of the household share a domestic kitchen. There are adequate bathroom and toilet facilities. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 17 There are three rooms for service users. Currently only two are in use. The service user at home on the day of inspection showed the inspector their room, which had been personalised with photos and pictures. Outside there are beautifully presented gardens and a summerhouse with comfortable seating and TV where one service user enjoys spending time. All areas seen by the inspector were well maintained and pleasantly furnished and decorated. Currently no one living at the home requires any environmental aids or adaptations. Regular safety checks are carried out in line with domestic practices. At this and every previous visit all areas seen were immaculately clean. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No staff are employed at the home therefore no standards in this section have been inspected. EVIDENCE: 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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 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, 39 & 42. The home is adequately managed and there are measures in place to ensure the health and safety of service users. EVIDENCE: The registered manager of the home is Mrs Veronica Hawkins, but the home is very much run as a partnership between her and her husband who both live at the premises. Veronica has worked in the care sector for some years and has managed her own home for 7 years. She has an NVQ Level 2 in Care and has undertaken some relevant short training courses. Both owners are able to demonstrate an excellent knowledge of the needs and likes of the service users who live at the home and have created an open and relaxed atmosphere. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 20 There are no formal systems in place to monitor or audit the quality of care offered but there is constant communication between the owners and service users. Each service user has an annual review with the home and care managers. Documentation in the home is basic but appropriate to the size and nature of the home. The manager is a qualified first aider and has recently undertaken a short health and safety course. The house is well maintained and there are regular checks to ensure the safety of the premises. Smoke alarms are fitted and these are tested monthly, fridge and freezer temperatures are taken regularly, a full electrical check has been carried out and the gas boiler is serviced annually. Appropriate insurance is in place. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 3 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 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 4 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
201a Berrow Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 22 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 37 Good Practice Recommendations The manager should undertake further NVQ training. 201a Berrow Road D53 - D02 S16279 201a Berrow Road V239606 230805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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