Inspection on 14/03/07 for 26 Tilmore Gardens

This inspection was carried out on 14th March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

CARE HOME ADULTS 18-65 26 Tilmore Gardens Petersfield Hampshire GU32 2JQ Lead Inspector Craig Willis Unannounced Inspection 14th March 2007 10:30 26 Tilmore Gardens DS0000067408.V326856.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 26 Tilmore Gardens DS0000067408.V326856.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. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 26 Tilmore Gardens Address Petersfield Hampshire GU32 2JQ 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) 01905 338626 Sanctuary Care Limited Mrs Patricia Ann Ranson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection since Sanctuary Care has provided the service at 26 Tilmore Gardens. Brief Description of the Service: 26 Tilmore Gardens is registered to provide personal care and accommodation to ten people with learning disabilities. The home is arranged in two houses, with an interconnecting door for staff. Each house has a kitchen, lounge / diner, a bathroom and separate toilet. There is an enclosed garden to the rear of the home that service users are able to access. The home is located in a residential area of Petersfield. The manager provided information to the CSCI on 27/12/06 that the fees at the home are £483.71per week. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The evidence used to write this report was gained from a review of the information the provider sent to the Commission for Social Care Inspection (CSCI), including a pre-inspection questionnaire, comment cards from relatives. A site visit to the home was made on 14 March 2007. During the site visit the inspector spoke with four of the service users, observed the interactions between service users and staff and spoke with the staff on duty. A phone conversation was held with the acting manager on 16 March 2007, as she was not present during the visit. A tour of the building was made and documents relating to the running of the home were inspected during the visit. What the service does well: What has improved since the last inspection? Not applicable. This is the first inspection since Sanctuary Care Limited has managed the home. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. 26 Tilmore Gardens DS0000067408.V326856.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 26 Tilmore Gardens DS0000067408.V326856.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): Standards 2 and 5. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are good systems to assess the needs of service users before they move into the home, although the lack of current information on terms and conditions of residence may leave service users unaware of their rights and responsibilities. EVIDENCE: The files of four service users were inspected during the visit. Each contained an assessment of their needs that was completed before they moved into the home. This assessment covers the individual needs of service users, including communication, personal care, mobility and cultural needs. The acting manager reported that as part of the assessment process potential service users would be encouraged to visit the home to meet with current service users and staff. There are no current vacancies at the home. Each service user had been provided with a licence agreement, setting out the terms and conditions of their residency, however these agreements were all with the previous provider that managed the service. Service users have signed documents to state they are aware of changes in the company managing the home, however, these do not contain any details of terms and conditions. 26 Tilmore Gardens DS0000067408.V326856.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): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has generally good care planning and risk assessment systems, which supports service users to make decisions about their lives and take managed risks, however, some of the language used in the care plans does not give clear information on how to meet needs. EVIDENCE: The personal files of four service users were inspected during the visit. Each service user had a care plan that was developed from their initial needs assessment. These plans are reviewed monthly and had been changed where the needs of the service user had changed. Service users spoken with said they discussed their care plans with their keyworker and were happy with the contents. It was noted that there were two incidents recorded of one service user being incontinent, although their care plan did not contain any information on what support should be provided to them. It was also noted that some of the language used in the care plans was not appropriate, for example one person is described as potentially being “extremely stroppy”; “In most cases 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 10 reprimanding is necessary”; and “should he go off the premises he should be severely reprimanded”. Staff spoken with said they would respond to these incidents in a supportive manner, explaining to a service user that they could have put themselves in danger by their actions. Service users spoken with said that staff treated them well and with dignity. This issue was discussed with the acting manager following the visit, who agreed that the wording could give staff the wrong idea about the actions they should take. The acting manager said she would review all of the care plans and change them where necessary. Care plans contain details of how service users should be supported to make decisions. These included detailed information on how staff should present options and communicate with service users. Staff were observed supporting a service user to get ready to go out for the day. This was done in a friendly manner and allowed the service user to decide whether or not to go. Risk assessments were in place for all service users whose files were inspected. These documents set out the assessed hazards to service users and action to minimise the risk of harm. The assessments also included the positive effects of taking risks, for example in developing greater independence and achievement for the service user. The risk assessments are regularly reviewed and changed where necessary. 26 Tilmore Gardens DS0000067408.V326856.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): Standards 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. The home provides good support for service users to take part in suitable activities, to maintain relationships with family and friends and to have a balanced diet of food they enjoy. Staff work in a manner that respects the rights and responsibilities of service users. EVIDENCE: Service users are supported to take part in a range of educational and leisure activities, including attending a local day service, visiting the library, shopping, indoor games and activities and social clubs. Service users spoken with said they enjoyed their activities and there were enough staff to support them. Service users are supported to keep in touch with family and friends and the home has an open visiting policy. Staff were observed providing support in a friendly and respectful way, which maintained the privacy and dignity of service users. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 12 The home has a planned menu that takes into account the likes and dislikes of service users and provides a varied and balanced diet. This menu is displayed in the kitchen in pictorial format to make it more accessible to service users. Service users spoken with said they were supported to prepare some of the food and they liked the food provided. Mealtimes are flexible, with service users having lunch at different times on the day of the visit due to the activities they were taking part in. The kitchens were well stocked with a variety of good quality food. Service users spoken with said they could have an alternative meal if they did not like what was on the menu. 26 Tilmore Gardens DS0000067408.V326856.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): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good support to meet the personal care and health needs of service users. The system for storing and administering medication is good and protects service users, although formal training for all staff will improve this. EVIDENCE: Details of the personal care support service users need are set out in their care plans. Service users spoken with said that staff treat them well and listen to and act on what they say. Staff spoken with demonstrated a good understanding of the needs of service users. Records are maintained of service users’ visits to health services, including GP, dentist, and optician. The records kept included details of any advice given by the practitioner. Medication is stored in a locked cabinet in the office and records are maintained of medication brought into the home, administered and returned to the pharmacist. Medication is regularly checked to ensure that the balance recorded matches the stocks held and that all administration records have been fully completed. Two of the staff administering medication have not had 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 14 formal medication administration training, although they have been given inhouse training. The manager reported that she is currently arranging for further training to be provided but was not able to say when this will happen. None of the service users are currently administering their own medication. 26 Tilmore Gardens DS0000067408.V326856.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): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident their complaints will be taken seriously and acted upon and the home has good adult protection systems, which helps to keep service users safe. EVIDENCE: The home has a complaints procedure available, which sets out who will deal with a complaint and how long the provider will take to respond. The procedure has been supplied to all service users in an accessible format and is also displayed in the home on a notice board. Service users spoken with said they know what to do if they want to make a complaint and were confident any complaint they made would be taken seriously. No complaints have been received since the last inspection. Both relatives who completed a CSCI comment card said they were not aware of the home’s complaints procedure. The manager confirmed by telephone that following the visit that she sent details of the procedure to all relatives to ensure they know what action to take if they wish to complain. The home has an adult protection policy and a copy of the local authority adult protection procedures. Staff have received adult protection training and those spoken with demonstrated a good understanding of abuse and action to take if abuse was reported or suspected. 26 Tilmore Gardens DS0000067408.V326856.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): Standards 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a safe, homely environment for service users. EVIDENCE: The home is arranged in two houses, with an interconnecting door for staff. Each house has a kitchen, lounge / diner, a bathroom and separate toilet. A tour of the communal areas of the home was made during the visit. The home is well maintained and has been recently decorated in all areas except the bathrooms. The manager reported that refurbishment of the bathrooms was planned for later this year, although they did not have a final date yet. Furnishings are domestic and of good quality. There is an enclosed rear garden that is shared by both of the houses and service users are able to access. The garage to the rear of the home is currently being converted into an activity room. Staff reported that there is a maintenance department and action is taken to ensure maintenance issues are followed up. There are currently no outstanding maintenance issues. The home has a separate 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 17 laundry room, which means laundry is not taken through food preparation of storage areas. There are hand-washing facilities in the kitchen, laundry room, bathrooms and toilets. All areas of the home seen during the visit were clean and there were no unpleasant odours. Service users spoken with said the home was always kept clean. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems to protect service users and meet their needs through the staff recruitment procedures. Staff training is generally good and gaps in training are being addressed. EVIDENCE: The manager reported that five of the nine staff employed have achieved the National Vocational Qualification (NVQ) at level two or above. During the visit, staff were observed interacting with service users in a friendly and respectful manner and those spoken with demonstrated good values of care. The manager reported in the pre-inspection questionnaire that two new staff have been employed since the service has been provided by Sanctuary Care and confirmed that Criminal Records Bureau (CRB) disclosures were obtained for these staff. These records were not viewed during the visit as the acting manager was not present and documents were kept locked to maintain confidentiality. One of the new staff members was spoken with and confirmed that the manager had obtained a CRB disclosure and references from previous employers. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 19 Sanctuary Care has a planned training programme, although staff spoken with said that they have had difficulty booking courses recently. The acting manager has completed a training needs assessment for all staff and reported that additional training was going to be made available. A record is kept of all training that staff have undertaken. Staff complete an induction based on the Learning Disability Awards Framework. Courses staff have completed include first aid, medication administration, moving and handling, food hygiene, fire safety, health and safety, adult protection, dementia and communication. The acting manager reported that additional autism training was planned due to the specific needs of some service users. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 20 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): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider has made good arrangement to cover the absence of the manager and there are good systems to promote the health, safety and welfare of service users and staff. There are good systems to gather the views of the service users as a way of assessing how the home is performing. EVIDENCE: The acting manager has completed an NVQ level 4 in Care and is staring work on the Registered Manager’s Award. The registered manager is currently doing an acting area manager job for Sanctuary Care. The acting manager reported that the new position will be reviewed by July 2007, and if necessary a permanent manager for the home will be recruited. CSCI had been informed of the management changes. Staff spoken with said they receive very good 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 21 support from the acing manager and are able to raise any concerns with her openly. The home has sent out questionnaires to service users and relatives to gain their views of the quality of the service that is being provided. Service users spoken with confirmed they have monthly meetings, when they can say what they think about the way the home is managed. The information from service users and their relatives is used to feed into a development plan for the organisation’s learning disability department. Senior managers from the organisation visit the home each month to review the service quality. Reports of these visits contain actions that are required to improve the service. The home has a fire risk assessment and regular checks are made of the fire warning system and the equipment. There are risk assessments for the building, which are regularly reviewed and contain actions that should be followed to minimise the identified risks. The gas boiler is serviced annually and annual tests of portable electrical appliances are completed. Assessments are completed for chemicals used in the home, which are stored in a locked cupboard in the laundry room. The temperatures of the fridge and freezer are taken daily and recorded. Accidents and incidents to service users and staff are recorded and reported where necessary. 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 22 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 2 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 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. 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. Refer to Standard Good Practice Recommendations 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 26 Tilmore Gardens DS0000067408.V326856.R01.S.doc Version 5.2 Page 25 - 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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