Inspection on 29/11/05 for 28 Southdown Road

This inspection was carried out on 29th November 2005.

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.

Other inspections for this house

28 Southdown Road 16/01/07

28 Southdown Road 31/08/05

28 Southdown Road 11/01/05

28 Southdown Road 17/08/04

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Insight - Eastchurch

Southfields

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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 28 Southdown Road Seaford East Sussex BN25 4PG Lead Inspector Jon Wheeler Unannounced Inspection 29th November 2005 2:00 28 Southdown Road DS0000021001.V274584.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 28 Southdown Road DS0000021001.V274584.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. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 28 Southdown Road Address Seaford East Sussex BN25 4PG 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) 01323 897877 southdownrd@onetel.com Southdown Housing Association Limited Ms Marion Love Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is five (5). Service users must be aged between eighteen (18) and sixty five (65) years on admission. Only adults with a learning and physical disability are to be accommodated. 31st August 2005 Date of last inspection Brief Description of the Service: 28, Southdown Road is owned by Southdown Housing Association and provides residential care to five younger adults who have learning and physical disabilities. The home is a purpose built bungalow situated in a residential area of Seaford. The home is close to the town centre and to public transport facilities. The home has two accessible vehicles. The home is well decorated and maintained, and has a friendly, homely atmosphere. There is a large lounge, and a spacious kitchen/dining room. Service users have their own bedrooms, all of which are pleasantly decorated, and contain the service users own pictures and furnishings. There is a well-maintained, secure garden to the rear of the property. There is level access throughout the home and the garden. Service users are supported to access a range of activities within the home and the local community. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection started at 2.00pm and lasted for three hours. The inspection involved talking to the manager and three members of staff. Because of their learning disabilities, the service users were not able to clearly communicate their views about the home. However, service users and staff were observed working together. The process also included a brief tour of the premises; reading care plans, policies and records; checking the administration and recording of medication. Those key standards not assessed at this inspection were assessed at the inspection of 31 August 2005. The home met all the standards assessed at this inspection. There was a wide range of evidence that the home continues to provide good quality care to the service users and to enable them to lead fulfilling lives. What the service does well: What has improved since the last inspection? The service has appointed new staff to ensure it is fully-staffed. Staff have undertaken a range of training courses to ensure they continue to meet the needs of the service users. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 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. 28 Southdown Road DS0000021001.V274584.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 28 Southdown Road DS0000021001.V274584.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): 2, 4. The service has a comprehensive pre-admissions policy and process, which enables the service to identify the needs of prospective service users and for the service users to visit the home prior to moving in. EVIDENCE: Whilst no new service users had moved in to the home for a number of years, the manager was able to describe in detail the policy and procedure for assessing prospective new service users. The policy clearly states that all prospective service users should be given the opportunity to visit the home on several occasions prior to choosing to move in. The manager said that initial visits would include the prospective service user meeting the people already living in the home, meeting the staff and perhaps staying for a meal. It was stated that prospective service users could be offered the chance to stay overnight, if they wished and if it met their needs, prior to making a decision to move in. 28 Southdown Road DS0000021001.V274584.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, 9. Service users’ needs and their required support are clearly documented in their care plans. Clearly assessed and managed risks enable service users to undertake a wide range of activities. EVIDENCE: Individual care plans contained comprehensive information about the service user. The plans had clearly assessed needs, background information and goals. There were clearly stated support guidelines to enable staff to meet the needs of each service user. The plans also contained information about service users’ likes and dislikes, family and friends, communication, daily routines and activities. There was documentary evidence that the care plans had been regularly reviewed and updated as necessary, to reflect any changes in need. There was documentary evidence of risk assessments and management plans to enable service users to undertake a wide range of activities in the home and in the community. Risk assessments had been regularly reviewed and updated as necessary. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 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): 11, 12, 13, 14, 16, 17. Service users are supported to take part in a wide range of activities to lead fulfilling lives, meet their needs and ensure their personal development. Service users play an active and fulfilling role in the life of their community. They are supported to maintain positive relationships with family and friends. The ethos of the homes promotes the right of service users to make choices in all aspects of their lives. Service users have varied and nutritious meals, which suit their needs and preferences. EVIDENCE: There was evidence that service users are supported to access a wide range of opportunities and activities in the home and in the community. Three service users access formal day care services, whilst the other two have their day activities planned and provided by the home. Four of the service users have a day during the week they spend at home, where they do their household tasks and to have one-to-one time with staff. Other activities include college courses, hydrotherapy, sensory room sessions, music group, exercise, trampoline and riding. Service users access a wide 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 11 range of activities in the community including cafes, pubs, clubs, theatre and concerts. All service users are offered an annual holiday. Staff were in the process of booking holidays for 2006 for the service users. Holidays are booked according to service users’ choices and needs. The manager and staff work hard to provide a wide range of meaningful and fulfilling activities to meet the preferences and complex needs of the service users. Service users are supported to play an active role in the community. The service has a flexible and innovative approach to ensure service users’ independence is maximised and they are able to make choices, where possible, in all aspects of their lives. Where service users are unable to express an informed choice, the service consults service users’ advocates, families and friends. Staff also use their experience and judgements to try to identify the preferences of each service user. During the inspection, staff were observed interacting with service users in a friendly, relaxed and confident manner. Staff were seen to be respectful of and sensitive to the needs and preferences of the service users. There was documentary evidence of a four-week menu, which provided varied and nutritious meals. Whilst service users do not currently have any particular dietary requirements, staff were aware of their preferences. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 12 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. Staff provide sensitive and dignified support to meet the individual needs and preferences of the service users. Service users are supported to access a range of health services to meet their physical and emotional health needs. The health and well-being of service users is safe-guarded by robust policies and medication being stored, dispensed and recorded appropriately. EVIDENCE: Staff were observed providing sensitive and dignified care to the service users, to meet their personal care needs. Staff had a clear knowledge and understanding of the needs of each of the service users. They ensured that any personal care is given in privacy to respect the dignity of the service users. There was clear and detailed support guidelines in the care plans for each of the service users. There was documentary evidence that service users are supported to access a range of health care services to meet their individual needs. All service users are registered with a local general practitioner. Medication was stored securely within the home. All staff have received training to enable them to safely dispense medication. The administration of medication had been recorded accurately, in line with the home’s policy and 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 13 procedure. The medication file included photographic identification of each service user, as well as their individual medication profile. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 14 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. Service users are able to raise concerns and complaints. They are protected from abuse by robust policies and procedures and with staff receiving appropriate training. EVIDENCE: The service has a robust complaints policy, although no complaints had been received by the home. Staff described how they were vigilant to gauge if they thought service users were unhappy. The manager said that relatives are encouraged to raise any issues or concerns either directly with the manager and staff, or at service users’ reviews. There was documentary evidence of an adult protection policy being in place, which staff were aware of. All staff had recently received updated adult protection training. Service users’ money is kept securely and money held in the home and their building society books are checked every day by a staff member. The manager checks the money and any receipts a couple of times a week. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 15 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, 25, 26, 27, 28, 29, 30. Service users live in a safe, clean and comfortable home, which provides them with sufficient communal space and toilet and bathing facilities. Service users have comfortable bedrooms and various adaptations, which meet their personal needs. EVIDENCE: The home was clean, tidy and hygienic and was in good decorative order. The home was purpose-built to meet the needs of people with learning and physical disabilities. There is a relaxed, homely environment offering comfortable and sufficient communal space, with large lounge and kitchen/dining areas. There are two large bathrooms, which provide adapted baths, a shower trolley and ceiling hoists, to meet the needs of the service users. The service users all have large, comfortable bedrooms, which are individually decorated and personalised with their own possessions and pictures. Three of the bedrooms have operational ceiling hoists. Each service user is able to spend time in their own bedroom, for privacy and rest. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 16 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): 31, 32, 33, 34, 35, 36. There is a skilled, experienced and well-trained staff team who continue to work hard to meet the complex needs of the service users. There are sufficient staff on duty to enable service users to lead fulfilling lives and to have their care needs met. The staff team are supported to provide consistent care and meet the needs of the service users with regular supervision and staff meetings. The organisation has robust employment procedures to protect the service users. EVIDENCE: Skilled and knowledgeable staff were able to describe their individual roles and responsibilities and those of their colleagues. Staff had a clear and in-depth knowledge about the individual needs of each of the service users and how the staff team consistently meets those needs. At the time of the inspection, the home was fully staffed and had no vacancies. There was documentary evidence that there are sufficient staff on duty for each shift to provide good quality care to the service users and to enable them to undertake a varied programme of activities throughout the week. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 17 The organisation has robust employment procedures. When new staff are employed, the manager of the home goes to organisation’s main office to witness that all the relevant information and checks on the new staff member have been completed. There was documentary evidence that the staff team are well trained to enable them to effectively carry out their jobs. There was evidence that staff had recently done update training in Moving and Handling. Three staff were doing a communication course, with five doing ‘active support’ training. All staff had recently done fire safety training. There was documentary evidence to demonstrate that full-time staff receive monthly supervision. Part time staff are supervised every two months. In addition, staff reported that they attended fortnightly team meetings. All staff spoken to said they felt well-supported and were able to raise any issues or concerns they may have. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 18 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, 38, 42. A skilled and experienced manager provides clear direction and support to enable the staff to provide good quality care to the service users. A range of regular health and safety checks ensure the health and well-being of service users and staff. EVIDENCE: The home is run by an experienced and skilled manager, who ensures a clear ethos and direction for the home, in line with the values and aims of the organisation. The manager has an appropriate management qualification and the NVQ4 in care. The manager demonstrated a clear insight and strategy in ensuring the home continues to monitor its practice to meet any changing needs of the service users. The manager is vigilant in monitoring the practice of the home, to ensure it continues to provide good quality care. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 19 Staff reported that the manager is approachable and supportive and provides a clear sense of direction for the team. Staff said they felt valued within the team and were able to raise any issues or concerns them may have. There was documentary evidence of the service having a range of health and safety checks. Staff had completed Moving and Handling and First Aid training. Fire safety equipment had been checked. Two staff are responsible for a weekly health and safety check, as well as a monthly ‘walk-through’ to ensure the home environment is safe. 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 20 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 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 X X X 3 x 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 21 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 28 Southdown Road DS0000021001.V274584.R01.S.doc Version 5.1 Page 22 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. 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