CARE HOME ADULTS 18-65
29 Albion Hill 29 Albion Hill Exmouth Devon EX8 1JS Lead Inspector
Teresa Anderson Announced 07 June 2005 10:00 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. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 29 Albion Hill Address 29 Albion Hill Exmouth Devon EX8 1JS 01395 276323 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) normanlea@normanlea.fsnet.co.uk Normanlea Society Mrs L Williams Care Home 8 Category(ies) of LD Learning disability (8) registration, with number of places 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 04 February 2005 Brief Description of the Service: 29 Albion Hill provides small, family type accomodation and personal care for up to 8 younger adults with learning disabilities who are physically able. The property is a four storey detached house with gardens to the front and rear. It is situated in a residential area of Exmouth and is within easy walking distance of the town and the local facilities. Bedroom accommodation is in single rooms, all but one with washbasin facilities. There is an open lounge/dining/kitchen facility on the ground floor. There is also a staff sleeping in room/office, a small laundry room, and a further office all situated on the ground floor. On road parking is available. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was undertaken as part of the normal annual inspection programme. It took place between 10.00am and 4.00pm on one day and between 11.00am and 12.30am the next. The manager completed a questionnaire prior to the inspection. Six comments cards were received from residents and two from relatives. All the residents were spoken with together with the manager, the administrator, three members of staff and the Responsible Individual (the person responsible for acting as the registered provider because the home is managed by a not for profit organisation). The majority of the premises were seen, inside and out, and care plans and recruitment and resident monies records were inspected. Throughout the inspection residents carried on with their daily lives. For many, this involved the excitement of getting ready for a holiday to the Isle of Wight. What the service does well:
Residents receive individual care based on sound and ongoing assessments and good care planning which includes the identification of personal needs and goals. Care plans demonstrate that appropriate advice is taken and referrals made to ensure residents’ personal and emotional health care needs are well met. Residents spoken with or who completed comments cards all indicated they like living at the home, that they feel well cared for and safe, that staff treat them well and respectfully and they are supported to make complaints where appropriate. They spoke positively of their achievements including paid employment and voluntary work. Comments included ‘this is the best place I have ever lived’ and ‘I am happier than I have ever been’. Staff receive training relevant to the services being offered and the needs of residents. They demonstrated an excellent understanding of relevant and important cultural issues and of residents’ rights. Residents share the housework, cooking and shopping - learning new skills with the support of staff. They take house decisions with the support of staff and have recently purchased a DVD player for the lounge and decided to plant a ‘Rose of Remembrance’ in the garden in memory of those residents’ parents who have died. Safe working practices ensure that residents are safe. Residents rights to take risks are balanced well against the resident’s right to protection.
29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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) 2 Residents benefit from an assessment process that has clearly identified their individual goals and needs. EVIDENCE: Care plans showed that all those who live at 29 Albion Hill have undergone comprehensive needs assessments. This forms the basis of each individuals care plan which identifies what that person likes to do and what they would like to do in the future. Any restrictions are discussed with and agreed by the resident involved. Residents spoke with the inspector about their lives and achievements. For example, one resident works in a local store whilst another works as a volunteer in a local care home. Residents also talked of the involvement of their families and friends and how staff helped to meet their needs. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 and 9. Residents’ benefit from the overall ethos of the home which encourages selfdetermination, independence and autonomy. The balance between risk taking and protection is well managed although could be improved by involving other professionals. EVIDENCE: Residents talked of 29 Albion Hill being their home and of how staff help to support them to live their own lives. For example, residents choose when to go to bed, what to eat, where to work, what activities they undertake, what they wear and what holidays they go on. Residents came and went throughout the inspection as they pleased, depending upon abilities, personal wishes and risk assessments. Care plans and discussions with residents’ show that any care given is provided in line with the resident’s wishes and in line with agreements drawn up between the home and the resident. This has included the recognition of and support for one resident who has been acting as a carer herself. Staff demonstrated an excellent understanding of relevant and important cultural issues, of the rights of residents to make their own decisions and to be independent and of residents care plans and preferences.
29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 10 Decisions regarding risk taking and annual reviews involve staff at the home and the resident. However, some residents would benefit from the involvement of the wider team to ensure that decision made on behalf of residents are made within a multidisciplinary framework. The manager is finding it difficult to achieve this. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 standard(s) 16 and 17. The home enables service users to cater for their own nutritional needs which further promotes independence. EVIDENCE: Throughout both days of this inspection, residents came and went according to their preferences and wishes. Staff and residents behaved as a family and were busy discussing events and holidays and preparing meals and drinks together. Residents talked of how they share the housework and cooking and of the normal family issues this presents. All communal areas are treated as such but bedrooms are private which only the resident can enter without knocking or permission. The residents usually take house decisions. They talked of how this had included a decision to plant a ‘rose of remembrance’ in the garden in memory of all parents of residents who have died, a decision to purchase a DVD for use in the lounge and a decision about where to go on holiday. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 12 Meals tend to be taken in the large dining room as a family, and residents decide what to eat (with advice on nutrition from staff). Snacks and drinks are freely available. Some residents really enjoy preparing the food and cooking. Residents, with the help of staff, undertake the shopping. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 standard(s) 18 and 19. Personal, physical and emotional needs are well met in a way that is acceptable to the individual residents. EVIDENCE: Each care plan describes how the resident likes to do things or how they like things done. This information is taken from the resident, or/and from family if appropriate. It is updated as needed and as changes occur. Staff demonstrated an excellent understanding of privacy and dignity issues and were observed putting this into practice throughout the inspection. The home employs a good balance of male and female carers allowing same sex care preferences to be respected. Care plans showed that appropriate advice had been taken and referrals made in order to ensure that the health care needs of residents are met. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 standard(s) 22 and 23. Residents are well supported by staff to share their concerns and complaints. They would be better protected if all staff received training in the protection of vulnerable adults. EVIDENCE: Residents said that they are completely happy at 29 Albion Hill – ‘the best place I have ever lived’, ‘happier than I have ever been’ and have no complaints. However, they said that if they did they would tell a member of staff. Weekly meetings are held which help residents to identify any issues or concerns. Not all staff have received training in the protection of vulnerable adults. Whilst they demonstrated an excellent understanding of the types of abuse which can occur, and a zero tolerance to this, training should improve their knowledge in relation to how allegations or incidents might be reported. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 standard(s) 24, 26 and 30. The home provides an excellent safe family environment for residents who are able to be involved in any changes to the décor and/or furnishings. EVIDENCE: Residents are obviously very proud of their home. They recently helped to choose new chairs and are helping to choose new carpets for those areas that need them. A resident showed the inspector around the communal areas of the home, around her bedroom and the rear garden. All areas are safe and accessible to residents and the home was clean throughout. One bedroom does not have a washbasin and whilst it was not possible to get this person’s opinion regarding this, staff report that this is not a problem for the current resident of that room. It was agreed that this would be kept under review. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35. Residents benefit from a highly motivated, well trained and experienced work force and from sound recruitment procedures which promotes their protection. EVIDENCE: Staff at 29 Albion Hill treat residents as their equals within a relaxed and informal relationship. Residents spoke very highly of them and were very complimentary about them. They say there is always someone to help them if needed. Staff receive training relevant to their learning needs and to the needs of the client group. This has recently included caring for people who challenge the service, a team building day, supervision skills and infection control. The manager has recently completed the Registered Managers Award and the Deputy Manager is undertaking an assessor’s course. Staff recruitment files demonstrate relevant checks, such as Criminal Record Bureau checks and the uptake of references, are made in order to protect service users. Residents and staff talked of how residents are involved in interviewing job applicants. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 17 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) 42. Residents’ needs in relation to health, safety and welfare are well protected by the procedures and systems in the home. EVIDENCE: The manager and staff ensure that safe working practices are in place. These include the fitting of magnetic door holders to some fire doors which comply with fire regulations but allows doors to be held open as preferred by residents; fire training (staff demonstrated a good knowledge of what to do in case of fire); fire drills and checks; mandatory training for example in first aid, food hygiene and infection control. Fire escapes have recently been cleaned to prevent slipping and are due for replacement in 2006. The house is alarmed and there is a good lock up procedure in place for residents safety and protection. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 2 x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
29 Albion Hill Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 19 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 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. 1. 2. 3. Refer to Standard 6 23 26 Good Practice Recommendations The registered person should ensure that care plans and risk assessments are drawn up with the involvement of the relevant agency as needed. The registered person should ensure that all staff receive training in the protection of vulnerable adults. The registered person should ensure that all bedrooms have wash hand basins. 29 Albion Hill D54 D06_s21844_albionhill_v221850_070605 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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