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 25 August 2005 16:00 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. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 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 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 Care Home 3 Category(ies) of Learning disability (LD) 3 registration, with number of places 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated will be three (3) 2. The people accommodated will be aged over eighteen (18) and under sixtyfive (65) years on admission Date of last inspection 26 January 2005 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 commual 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 on the ground floor. The bedrooms and one bathroom and toilet is 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. There is a large back garden, which has an uneven terrian. The house is in walking distance to the local shops, and is near the main bus route to Hastings and St Leonards on Sea town centres. The house is home to three younger adults with learning disabilities. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced routine inspection (first of two planned before April 1st 2006), which took place between 16.00 and 1800. The inspector is familiar with the service hence a number of judgements were made from previous knowledge, confirmed by observation and talking with service users and the staff member on duty. The manager was not on duty, and therefore confidential files on staff were not available for inspection. The inspector had an extended discussion with the staff member on duty and she assisted the inspector throughout the visit. The inspector toured the home, which included all bedrooms, bathrooms, and communal areas including the kitchen. Care plans and Health and safety documentation were inspected. The two women living in this home at this present time wish to be referred as residents within this report. What the service does well: What has improved since the last inspection?
The home is part of the EVH organisation and continues to focus on staff development and training including induction, health and safety and first aid. The home has carried out certain repairs and redecoration in the home which include fitting of fire doors, a window restrictor in bathroom and the removal of the old greenhouse in the garden. One resident who was posing a risk to another resident and was excessively disruptive for many months has been supported to move on, and home during this visit was much calmer. One resident stated when interviewed that the home is much better now the third resident has left. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 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. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 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 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 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) 1,2,3,4 & 5 Residents are given all the information they need to be able to make an informed decision to live at 24 Tower Road West. EVIDENCE: There have not been any new residents to the home since the last inspection; however, there is now a vacancy. The home has a comprehensive policy and procedures in place for prospective residents. The home is part of the East View Housing Organisation and has detailed policies and procedures in place for prospective residents. The residents living the home have copies of their contracts statement of purpose and Service Users’ guides in their care plans. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 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 The staffing levels within the home at this present time, are affecting the residents’ independence and overall quality of life when both are at home, especially for one of the resident who is experiencing a psychotic episode, and that this is affecting the quality of life for the other resident. EVIDENCE: At the time of this inspection, one of the residents was experiencing a psychotic episode and this does affect the other resident. The inspector was informed that the other resident is unable to go out because staffing levels are one staff per shift, and for the last 5 days the resident has not been able to go out apart from attending day services. The inspector spoke to the resident about not being able to go out, but she is very fond of the other person and has accepted that when the other resident is not well they cannot go out so often. However, the health needs of others should not affect the quality of life of other people living in the home. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 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 standard(s) 11,12,13 & 14 When residents are well they enjoy a range of activities in the community. However, there is a limited choice for service users to remain at home if they wish, as one resident does not enjoy the day centre. EVIDENCE: Due to the staffing rota, and now only being two residents living at the home, they are restricted to participate in community activities independently with only one member of staff on duty. Staffing of the home in the daytime is still mostly restricted to taking residents to appointments or supporting them through illness. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: None of these standards were assessed. Standards 18,19,20 & 21 will be assessed at the next inspection. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 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 standard(s) 22 & 23 Residents feel confident to raise concerns, as they know they will be listened to and action taken to resolve them. Protection from abuse is promoted through staff training and an understanding of the support and actions they may need to take. EVIDENCE: One resident spoke to the inspector about the recent incidents within the home, when she was being bullied and abused by another resident. The incidents were taken very seriously and Adult Protection measures were taken. It was evident she had been supported by the staff and now the other resident has left the home, and she now felt safe. Copies of the complaints procedures are available in the home. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,27,28 & 30 Residents live in a warm and homely environment. However there are outstanding areas of repair that are the responsibility of the Landlord, which has been outstanding for over two years. EVIDENCE: The inspector toured the home and saw all the bedrooms, bathrooms and communal areas and it was evident that this is really the residents’ home. There are still outstanding requirements from the last inspection with regards to the structural cracks on the outside walls of the property. The house is large and the two people in residence have lots of space. Bedrooms were found to reflect the residents taste and interest, and they were very tidy. The home was very clean and free from any offensive odours. The home has a small laundry room off the kitchen, but within this room there are no facilities to wash hands, and there was no evidence of protective gloves or aprons, or the disposal of such items. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34 &35 The staff do receive support and supervision, but there is a special training needed by staff to support the service users through mental health issues. With the special needs of the residents now living in the home, there a need to review the staffing levels to ensure residents are fully supported in all aspects of their lives. EVIDENCE: EVH has a robust recruitment policy and all staff undertake induction and mandatory training. The management of the home have also recognised that the residents have mental health issues, and training for the staff in the areas of mental health has been arranged for the staff team. This was evidence during this inspection with one resident was having a serious psychotic episode and the Community Mental Health Nurse was visiting regular to give medication and support. Unfortunately the staff member on duty during this inspection had been informed that mental training session had been cancelled, but other dates would be arranged. The staff member recognised that the residents living at 24 Tower Road West do have mental health issues and as such the staff need special training to enable them to support the residents. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 15 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) 37,39 & 42 The residents benefit from a well motivated manager and staff team. The home has had a difficult time, but the home was calmer during this inspection. However, the resident having a psychotic episode was very demanding on the staff to the exclusion of the other resident. EVIDENCE: All health and safety documentation was in place, and records confirmed that all staff have completed or are in the process of completing First Aid, Fire, Moving and Handling and Food Hygiene training. The manager was not present and therefore confidential information and documents were not seen at this inspection, however the staff member confirmed that the manager was very supportive and the staff worked well as a team. The staff do not often work together, the rota is scheduled for one member of staff per shift. This staffing level should be reviewed to ensure all the residents’ needs are met. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 3 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 1 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 2 2 3 x x x Standard No 31 32 33 34 35 36 Score 3 2 x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
24 Tower Road West Score x x x x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 3 x H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 17 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 YA7 YA9 Regulation 12(3) 13(4)(b) Requirement The manager must ensure that staffing levels within the home are reviewed, to ensure that residents are supported, consulted and encouraged to have independent lifestyles within a risk assessed environment. The manager must ensure that there are the appropriate level of staff on duty to ensure the residents have the opportunities to become part of and participate in the local community in accorance with their assessed needs. The manager and the Responsible Individual must have the back wall of the premisies investigated and repaired. This is a requirement from previous inspections. The manager 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. Timescale for action 31/11/05 2. YA12 YA13 16(2)(m) (n) 31/11/05 3. YA24 23(2)(b) 31/11/05 4. YA32 YA35 12(4)(b) 31/10/05 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 18 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 YA30 YA37 Good Practice Recommendations It is recommended that the manager undertakes a risk assessment on the handling of laundry and hygiene practices of the residents and staff within this area. It is recommended that the manager becomes the registered manager. 24 Tower Road West H59-H10 S21319 24 Tower Road West V243447 250805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 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
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