CARE HOME ADULTS 18-65
24 Tower Road West 24 Tower Road West St Leonards-on-sea East Sussex TN38 0RG Lead Inspector
Jeanette Denereaz Unannounced Inspection 12th January 2006 02:30 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 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 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 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. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 24 Tower Road West Address 24 Tower Road West St Leonards-on-sea East Sussex TN38 0RG 01424 427607 01424 721862 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) East View Housing Management Ltd Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of residents to be accommodated will be three (3) The people accommodated will be aged over eighteen (18) and under sixty-five (65) years on admission. 25th August 2005 Date of last inspection Brief Description of the Service: 24 Tower Road West is a large Victorian house, rented for its services users by East View Housing Management Limited (EVH). The house has a wide hallway and there are three communal rooms on the ground floor. There is a lounge, dining room with a smaller room next to the kitchen. There is also an office and a downstairs toilet. The bedrooms and one bathroom and toilet are on the first floor. The third floor is office space for the Health and Safety Officer of EVH; the CSCI has been assured the office is always locked when not in use. The back garden is large and has an uneven terrain. The house is in walking distance to the local shops, and is near the main bus route to Hastings and St Leonard’s on Sea town centres. The house is registered for three younger adults with learning disabilities. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection took place on the 12th January between 14.30 and 17.00. The overall focus of the inspection was on meeting with the residents and staff members on duty. Time was spent meeting with the residents and staff, inspecting a number of records, policies, procedures and other documentation. A full tour of the home was undertaken including bedrooms. The inspector spent time with the resident at home, and briefly met with the other resident on her return from the day centre. The staff member on duty on the inspector’s arrival usually is employed at the day centre, and had been seconded to undertake 1:1 work with a resident, who does not now attend the day centre, but has an in- house day service programme. At 3pm there was a changeover of staff, and this staff member was part of the home’s residential staff team. As this report was made following the second unannounced visit, and does not cover all the standards, therefore for the reader to make a judgment about the home, it is recommended that a copy of the last inspection report of the 25th August 2005 also be obtained to have a clearer picture of the home. Since the last inspection the manager has left the service, and at this present time only two female residents are living in the home. The Inspector was informed that the home is being overseen on a temporary bases by the manager of the Reilly House day service (which is part of the EVH organisation), but she was no present at this inspection. What the service does well: What has improved since the last inspection?
At the last inspection there was a concern that because the home had only two residents, the staffing levels had reduced. The residents have differing social and lifestyle needs, one needing a slower lifestyle and the other enjoys going out. However, the inspector was assured that the resident’s lifestyles are now supported, and in the winter they tend to stay home more. This situation should be reviewed in the coming summer months.
24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 6 The bathroom is in the process of being re-decorated. 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. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 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 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 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 the following standard(s): The key standard 2 was inspected at the last inspection on the 25th August 2005 and was met. EVIDENCE: The home has not been any new residents since the last inspection. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 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 the following standard(s): 7&9 The situation within the home and the staff levels at this time has settled since the last inspection, and residents are now receiving a better quality of life. EVIDENCE: At the last inspection one of the residents was experiencing a psychotic episode and because the home had only two residents the staffing levels had been reduced and were restricting social activities for the residents. The staffing rota has been reviewed, and in the winter months the residents tend to choose to stay at home more especially in the evenings. However, this situation needs to be reviewed by the management in the coming months so the staffing of the home does not affect the quality of life of the residents or restrict their activities. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 15,16 & 17 As confirmed at the last inspection when the residents are well, they both enjoy a range of activities at home and in the community. EVIDENCE: It was evident during this inspection that the staff have respect for the residents, and they are respect this is the residents’ home. The staff member on duty stated that all staff knock before entering the residents bedrooms. All bedroom doors are lockable and the residents hold the keys, but when they are at home they prefer not to lock the doors. The residents have regular contact with family and friends, and visits and telephone call are recorded in their care plans to confirm this. The menus were discussed and the residents confirmed that they were totally involved in the planning, shopping and preparing of meals. The refrigerator and freezer were inspected and found to be clean, and full of food. The temperatures of both appliances were regularly checked and recorded appropriately.
24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 18,19 & 20 The residents have physical and emotional health needs, and the staff try to support them, but they lack the knowledge and experience. However, at crisis times professional help is sort to support the residents. EVIDENCE: Both the residents are registered with a local GP, and they have access to all other health services. There is regular input form the local Community Learning Disability Team (CLDT). However, from recent incidents within the home, and speaking with the staff, it is evident that they are still not adequately trained in meeting the mental health needs of the residents at times of psychotic episodes and challenging outbursts. Medication within the home is supplied by a local pharmacist, and the pharmacist undertakes regular audits within the home, and the most recent audit was very positive. The inspector also inspected the medication and records and was found to be in order. All staff are trained to administer medication, and at this present time no resident is self-medicating. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 12 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 the following standard(s): Both the key standards 22 & 23 were inspected at the last inspection of the 25th August 2005 and were met. EVIDENCE: There has been an incident within the home since the last inspection involving a resident and member of staff. The incident was dealt with appropriately by EVH and all actions were taken, and the situation has now been resolved. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 13 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 the following standard(s): The residents continue to live in a warm and homely house. However, as stated in previous inspection there are outstanding areas of structural repair which should be rectified by the private Landlord; but is the responsibility of the EVH as the registered providers to ensure residents live in a safe environment. EVIDENCE: There are still outstanding requirements from the previous inspections with regards to structural cracks on the outside walls of the property. EVH has made the Landlord aware of the situation, but to date has ignored requested for the work to be undertaken. However, it is the responsibility of EVH to ensure that residents live in a safe environment. There is also a concern regarding the handling of soiled launder and the hygiene practice of the residents and staff. It was recommended at the last inspection that a risk assessment be undertaken. There was no evidence that this had been done, and at times soiled laundry is taken through the kitchen area where food is stored and prepared to the utility room, and the utility room has no hand washing facilities. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 14 The front garden is very untidy and overgrown and is not welcoming for the residents of visitors. On the day of inspection the home was warm, clean and free from offensive odours, and the bathroom was in the process of being decorated. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 35 As stated at previous inspections and now following the recent incident between a resident and staff member, there is a need for staff to be supported and have the appropriate training to fully support the residents at 24 Tower Road West. EVIDENCE: There is evidence that the staff have had basic training and support from the CLDT, but following the recent incident and speaking to the staff, there still is a need for further training to support the residents. The staff recognised that the residents to have mental health issues and at times is acerbated and at such times they needs the skills to deal with these situations for the safety of the residents and themselves. No staffing records were inspected with no senior management on duty there was no access to confidential information. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The residents need stability, and at this present time there is no registered manager in post. There is a need for a manager to be appointed for the stability and management of the home, as the resident have complex needs and the staff need leadership to ensure residents are safe and receive the appropriate service. EVIDENCE: The manager has recently left the service, and the manager of the day centre is overseeing the management of the home. This is only a temporary situation and is not satisfactory to ensure the residents receive an appropriate service. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 17 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 X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
24 Tower Road West Score 3 2 3 X Standard No 37 38 39 40 41 42 43 Score 1 X X X X X X DS0000021319.V261164.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes 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 YA19 Regulation Requirement Timescale for action 01/05/06 2 YA24 3 YA32YA35 4 YA30 12 The Responsible Individual 13(1)(a)&(b) must ensures that all the staff working in the home, can met the healthcare needs of the resident. To ensure they can assess and recognise mental health issures and have preocedures in place to address them. 23(2)(b) The Responsible Individual must have the back wall of the premisies investigated and repaired. This is a requirement from previous inspections. 12(4)(b) The Responsible Individual must ensure that the staff have the competencies and qualities required to meet residents needs, and they should have the training and development programme to meet the changing needs of residents. This is a requirement from previous inspections. 13(3) The Responsible Individual 16(2)(k) must ensure a risk assessment is undertaken on the handling and sluicing of laundry and
DS0000021319.V261164.R01.S.doc 01/06/06 01/05/06 01/05/06 24 Tower Road West Version 5.0 Page 19 5 YA37 8&9 hygiene practices of the residents and staff within this area. This is a recommendation from previous inspection. It is required that the responsible individual must ensure the home has a registered manager that is qualified, competent and experienced to run the home and meet the changing needs of the residents. 01/06/06 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 2 Refer to Standard YA33 YA24 Good Practice Recommendations It is recommended that the Responsible Individual review staffing levelling during the summer months t ensure the residents are supported to access the wider community. It is recommended that the front garden be cleared to give better access and be more welcoming for the residents and visitors to 24 Tower Road West. 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI 24 Tower Road West DS0000021319.V261164.R01.S.doc Version 5.0 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
