Inspection on 25/01/06 for 25 Horsegate

This inspection was carried out on 25th January 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

25 Horsegate 05/09/06

25 Horsegate 10/08/05

25 Horsegate 08/02/05

25 Horsegate 05/08/04

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 25 Horsegate Deeping St James Peterborough PE6 8EW Lead Inspector Mick Walklin Unannounced Inspection 25th January 2006 11:30 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 25 Horsegate Address Deeping St James Peterborough PE6 8EW 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 347037 www.sense.org.uk Sense East Mr Albert Pearce Care Home 6 Category(ies) of Learning disability (0), Sensory impairment (6) registration, with number of places 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 sensory impairment/learning disability Date of last inspection 10th August 2005 Brief Description of the Service: 25 Horsegate is a modern house, built around 7 years ago. It is situated in the village of Deeping St James, approximately one mile from the centre of Market Deeping. There are a range of shops and pubs nearby, and the centres of Peterborough, Stamford and Bourne are within a short driving distance. The home is of a domestic appearance, and situated in a residential area. It is registered to provide accommodation for 6 people with a sensory impairment and/or learning disabilities. The aim of the home is to provide a safe and supportive environment, based on best care values. The home is part of a group of homes managed by SENSE East. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of 6 hours. The main method of inspection used was called case tracking which involved tracking the care the three residents receive, through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the premises was conducted, and documentation relating to the management of the home was also inspected. What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments should be reviewed and updated to ensure that they meet the current needs of residents. The practice of disguising medication in chocolate bars and drinks must be reviewed, to ensure that the pharmacist has agreed this, that consent issues have been considered, and that the practice is in the best interests of the residents concerned. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 6 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. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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): No standards in this section were inspected. EVIDENCE: 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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): 6 & 8. Care plans and risk assessments still require updating so that they reflect the current needs of residents. Staff ensure that residents are involved in the running of the home. EVIDENCE: Residents files contained a range of background information, and there was evidence of six-monthly reviews being held, which included parents and placing Social Workers. The previous inspection identified that it was sometimes difficult to link specific care plans and risk assessments directly with the reviews, and some care plans and risk assessments had not been rewritten since 1999. Some care plans had not been signed by the person completing them. There was evidence that care plans are now in the process of being updated, but the manager explained that because of the high workload, and instances of challenging behaviour, this process has not been completed. There are excellent behavioural guidelines, signed by staff to confirm that they had read them. These are regularly reviewed and monitored, with excellent incident analysis and risk assessments. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 10 Residents are encouraged to participate in all aspects of household tasks, as their risk assessment allows. Residents have timetabled home days in order to concentrate on independent living skills. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 16 & 17. There are good occupational, recreational and leisure opportunities available for residents to ensure that they have a varied and interesting timetable. EVIDENCE: Residents presently attend Peterborough Resource Centre (PRC), and have a varied timetable designed to promote independence. Residents have detailed aims and objectives, and short and long-term aspirations for all activities undertaken at PRC. A new resource centre with better facilities is due to open in Bourne in the next few weeks, and residents will transfer to this. However, there will be a transitional period during which no day service will be available, and residents will participate in home based activities. Staff said that they will be using photographs to help explain the transition between the services to residents. Residents make extensive use of local community facilities, including pubs, restaurants, bowling and cinema. Most residents require assistance in deciding what activities to participate in, and staff offer then a range of options. All 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 12 residents have some degree of communication difficulties, and staff use a variety of alternative methods including sign/support English, British Sign Language and the use of objects of reference to assist verbal communication. All residents have good communication guidelines included in their care plans. Catering arrangements are of a domestic nature, and enable individual needs to be catered for. Eating and drinking guidelines are in place for some residents, and a record of food served is kept to ensure a good diet is maintained. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 & 20. Resident’s health needs are identified and met, but medication administration practices need review. EVIDENCE: Staff gave examples of how they maximise resident’s privacy, dignity, independence and control over their own lives, but pointed out that residents require a very high level of support and supervision in all aspects of their lives. Health action plans have been introduced, which identify any health needs. All residents are registered with the local GP practice. Local opticians and dentists are used. Sense East employs a person to conduct visual and hearing assessments, and copies of detailed reports were seen on file. There was also evidence of regular weight checks. A Consultant Psychiatrist has recently been involved with one resident, and a meeting, involving Psychologists from the local Healthcare Trust, was being held at the time of the inspection. All staff who administer medication undertake training and a competence assessment with the deputy manager. There are good systems for medication storage and stocktaking. The home uses a Nomad system, where tablets are pre-packed by the pharmacist. Three residents have medication administered covertly, using chocolate bars or drinks. However, there was no documentary evidence as to how the decision to use this method of administration had been reached. In particular, there was no evidence that consent issues have been 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 14 considered, that agreement from the pharmacist had been obtained, and that the practice is considered in the best interests of the residents concerned. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 the following standard(s): 22 & 23. There are effective procedures in place for dealing with complaints and adult protection issues, ensuring that residents are safe. EVIDENCE: There have been no complaints since the last inspection, and staff were clear on how to deal with complaints, should they receive one. The home’s ‘Resolving Issues’ guidelines contain contact details for the Commission. Staff are required to complete an annual adult protection questionnaire as part of their appraisal. This is reviewed by the training Manager to ensure that staff demonstrate an adequate knowledge of the procedures. Staff interviewed had a good knowledge of the procedures for reporting suspected abuse, and were clear about the location of policies and procedures, including the Lincolnshire Adult Protection Committee procedures. Adult protection is also an agenda item at staff meetings. At the time of the last inspection, the ‘Emergency File’ did not contain clear guidelines or contact numbers for staff to follow, and these are now included in the file. SENSE East has a Protection Committee, which reviews all reports of adult abuse within the organisation. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 the following standard(s): 24 & 30. There have been further improvements to the environment, which is comfortable and homely. EVIDENCE: A new settee and armchairs have been purchased since the last inspection, and a new carpet has been fitted in the lounge. Previous inspections have highlighted maintenance problems, with delays in attending to issues. The manager reported that there has been an improvement in maintenance responses. The environment is generally clean and pleasant, but the ceiling and walls in the living room were stained where drinks had been thrown. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 & 36. Staff are well trained and supported, and employed in sufficient numbers to meet the needs of residents. Recruitment and selection procedures are robust to protect residents. EVIDENCE: There are sufficient staff on duty to meet the needs of residents, and the staffing situation has improved since the last inspection. A new system for booking bank staff has been introduced, and staff complained that this can affect the continuity of care, and bank staff may not know the residents. The files of three newly recruited members of staff were inspected, and all contained the documentation necessary for the protection of residents, and one of the staff confirmed that the recruitment and selection procedure had been formal. Staff confirmed that they had undertaken mandatory training, but training records are computerised, and were not available for inspection. The last inspection highlighted that staff were not receiving regular formal supervision. Supervision is now carried out by the manager, deputy and two senior staff, and records demonstrated that as from September, regular supervision had been occurring. Resident’s behavioural guidelines direct staff to the manager for support, if they are finding it challenging working with particular individuals. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 18 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39 & 42. There are good quality monitoring procedures, and health and safety checks ensure that the environment is safe for residents and staff. EVIDENCE: Staff said that they have had “a tough time” dealing with the challenging behaviour of one resident over the past few weeks. They conceded that this had affected staff morale, but one said “ but in the end, that’s what we’re here for”. Sense East has good systems for monitoring the quality of care provided on an annual basis. They use self-assessment questionnaires, staff focus groups and questionnaires for staff, purchasers and parents. The deputy manager is responsible for health and safety checks, and Sense East employs a Health and Safety Officer who produces regular safety bulletins. Documentation is well organised, and routine checks were up to date. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 20 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 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 x 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 x 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x x 3 4 x x 3 x 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 22 Yes 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 Requirement The registered person must ensure that care plans and risk assessments are updated and reviewed. (Timescale of 31/12/05 not met, but some progress has been made). The registered person must review the practice of covert administration of medication, to ensure that the pharmacist has agreed this, that consent issues have been considered, and that the practice is in the best interests of the residents concerned. Timescale for action 30/06/06 2. YA20 13(2) 30/04/06 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. Refer to Standard YA23 Good Practice Recommendations It is recommended that a quick reference guide and contact numbers is included in the Emergency File. DS0000002655.V278560.R01.S.doc Version 5.1 Page 23 25 Horsegate 2. 3. YA36 YA38 It is recommended that staff receive supervision six times per year. It is recommended that the manager be allocated sufficient supernumerary time to fulfil his role. 25 Horsegate DS0000002655.V278560.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. 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