CARE HOME ADULTS 18-65
3 Tensing Close Fareham Hampshire PO16 7QE Lead Inspector
Sue Kinch Key Unannounced Inspection 11th September 2007 09:00 3 Tensing Close DS0000067323.V338771.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 3 Tensing Close DS0000067323.V338771.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. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 3 Tensing Close Address Fareham Hampshire PO16 7QE 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) 01329 822170 01329 822170 www.hantspt.nhs.uk Hampshire Partnership NHS Trust To Be Confirmed Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: 3 Tensing Close is a detached bungalow situated in a quiet residential area on the outskirts of Fareham. 3 Tensing Close has three single bedrooms. Communal space includes a lounge/diner. There is a large patio area, leading from the lounge, and a fair sized garden Hampshire Partnership NHS Trust (the Trust) manages the care provision and a housing association undertakes the housing management. Fees are variable based on agreed rates for block contracts with social services and individual needs. Fees exclude some transport for leisure and holidays, toiletries and personal effects. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection visit took five hours and included evidence from conversations with the two people living in the home, the manager and a member of staff. Other evidence was gathered through observation of day-today interaction, viewing records and the physical environment and through questionnaires including information from external professionals and an advocate. Information received about the service since the last inspection, held in the service folder was also taken into account. This included an Annual Quality Assessment Audit (AQAA) submitted by the home’s management. What the service does well: What has improved since the last inspection? What they could do better:
Work is still needed to ensure that: all staff have received the training needed; that all risks are fully assessed; to improve the kitchen, the external paint and wood work and the windows; and to ensure that all staff have access to the online policies and procedures of the trust but the manager said that plans were in place to address all of these. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 6 One requirement has been made to ensure that full staff records are held at the home of any person providing care in the home unless an agreement has been made with CSCI. 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. 3 Tensing Close DS0000067323.V338771.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 3 Tensing Close DS0000067323.V338771.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit from an admissions process, which includes an assessment of their needs before moving into the home. EVIDENCE: In the AQAA the manager stated that a referral and admission procedure is in place, which includes a referral assessment and, introductory visits. She also stated that the service users guide had been updated and reviewed in the last twelve months. A new resident has not been admitted since that last inspection when processes were found to be satisfactory. Therefore this section was assessed further at this inspection. But it was noted that the manager had planned to meet for preliminary discussions with a prospective resident in the week after the inspection. 3 Tensing Close DS0000067323.V338771.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): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff using clear, regularly updated care plans based on recent joint assessment of residents’ needs and preferences, positively support people living at the home. EVIDENCE: The personal files for the two people living in the home were viewed during the inspection. Both had been re-written since the last inspection and reviewed regularly. One file was discussed with a member of staff and a resident and during the discussion the member of staff showed a good working knowledge of the needs and preferences of the resident. Information from the resident about needs and wishes was also reflected in the care plan. The member of staff was noted to be working and supporting both residents throughout the day in line with their care plans.
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 10 The care plans are well organised and comprehensive and include personal profiles and up to date risk assessments addressing individual safety issues. A requirement had been made about risk assessments at the last inspection and this had been addressed. One further issue of safety relating to use of the garden, was discussed with the staff member during the inspection and the manager agreed to ensure that another risk assessment would be swiftly completed in respect of this. Guidance for staff, in the care plans was sampled and included key information for meeting communication, health, and emotional and social needs. The residents are aware of their care-plans and their understanding is aided by the use of symbols. Throughout the inspection it was noted that the member of staff working was taking the wishes of residents into account in terms of the timing of tasks and enabling their decision-making. 3 Tensing Close DS0000067323.V338771.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): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a range of regular, community based activities that they want to be involved in with support from staff although this could be enhanced further by more staff being able to drive the house car. Residents receive positive staff support with relationships and friendships. Residents enjoy being offered healthy food that they like and being involved in meal planning and shopping. EVIDENCE: As found at the previous inspection the social and emotional needs of residents are assessed and plans are in place to provide opportunities to meet those needs. Both people living at the home have a regular weekly schedule, which includes use of the community groups and day services. Day-to-day records are written and recent entries recorded that these activities were taking place.
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 12 One resident spoke about a recent day trip and, of looking forward to a planned holiday in the week after the inspection. A member of staff gave examples of supporting people with shopping or going to the cinema and of supporting visits to friends and going out for meals. In the AQAA the manager referred to some restrictions on activities due to financial constraints. Records stated that one resident needs support from two staff in the local community and a member of staff confirmed this and said that therefore most activities have to be planned in advance. She also said that the planning also had to take into account the fact that only two staff can drive the house car. It was recommended that further consideration be given to ensure that needs continue to be met. The provider has subsequently stated that four staff are able to drive the house car. Residents continue to like the food that is provided in the home and said that they did have their favourite foods sometimes. At the last inspection this was evidenced in the food records, which showed that individual needs are taken into account. A staff member said that they involve residents in the menu planning and shopping and those other options can be chosen when shopping. The staff member said that menus are discussed regularly so that residents know what is for meals. In a recent staff meeting the budget for residents’ food was discussed and a weekly amount set. The member of staff on duty said that it was possible to cater to meet individual needs within this budget. This will also need to be monitored to ensure that residents’ preferences continue to be provided for. 3 Tensing Close DS0000067323.V338771.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): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain good health and receive individualised personal care. Procedures are in place to deal with medication safely. EVIDENCE: As found at the last inspection staff members provide residents with help and assistance with personal care. Evidence of this was apparent in discussions with residents individually and with a staff member. The staff member supported one person with personal care during the inspection and the description of the support given matched with the wishes written in the care plan. The resident was able to have support at their preferred pace and appeared relaxed before and after the help received. The member of staff promoted privacy and dignity. During this time the member of staff kept checking the wishes of the resident. The care plans include details of the health needs of residents. A sample of records of health needs was viewed and was in line with issues discussed with the residents and the member of staff. The member of staff gave information
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 14 about how one resident had been worked with on one particular health matter and how this had been resolved .The resident confirmed this. Records of visits to appointments were viewed in two files checked and corresponded with the verbal information given. Health professionals are involved in meeting resident’s needs. A requirement was made about medication at the last inspection, as some medication was not locked in a drawer in one room and out in the open in another. At this inspection in one room checked the medication was held in a lockable drawer, which was not locked properly. This was rectified and the manager and member of staff said that it had been locking and the manager agreed to make further checks. Other medication was stored properly. Training records documented that the member of staff on duty had been reassessed for administering medication in May 2007. Assessments within the last year were also in place for staff in two other files assessed. The member of staff administered medication sensitively during the inspection explaining the wishes of the resident involved. A of a sample of medication was checked against the administration records and stock records and this was accurate. 3 Tensing Close DS0000067323.V338771.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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are able to air their views and complaints are addressed, and are protected by appropriate use of local adult protection procedures. EVIDENCE: At the last inspection talking about problems and complaints was discussed with two residents who said they would talk to staff if they had any. No complaints were made at this inspection. A written comment from care professionals external to the home stated that the home responds appropriately to any concerns raised. In the AQAA the manager said that the complaints procedure had been reviewed and updated and that one complaint had been received in the last twelve months. At the site visit it was noted that the complaint had been documented in the complaint book and the outcome recorded. It was noted that when the home is monitored during Regulation 26 visits by the provider the complaints book is checked. Adult protection was discussed with a member of staff who had received training before but said that further training was planned. The member of staff was aware of a range of potential issues that could be considered to be abuse and of their role should an allegation be made. The member of staff was aware of notifying the manager or on call person immediately and said that there was
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 16 always a manager to consult. Advice was given to be familiar with the roles of involved parties following initial reporting. In the AQAA the manager stated that staff are trained and procedures are in place. Locally agreed procedures were held at the home and staff training plans showed that further training is being planned for some staff. The staff and management of the home manage residents’ personal finances. A sample of records was checked and reflected the money held. The Trust has a policy of residents having to seek agreement from management to spend over £20. A staff member said that this did not affect the current resident’s day-today decision-making. However, this will need to be monitored to ensure that current and future residents’ rights are upheld. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 17 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): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents will benefit from the plans in place to address the deterioration in the physical environment such as the windows, external paintwork, the patio and kitchen. The new cleaning schedules in place will improve the cleanliness and hygiene in the home. EVIDENCE: At this inspection it was noted that some work to the environment had taken place. Staff reported that two bedrooms had been repainted in the last year and one person had just had a new bedroom carpet. At the last inspection it was found that the external presentation of the home had deteriorated and looked unkempt with flaking paintwork to the front of the house and porch. Staff and management had said that negotiations were underway to address this. At this inspection the manager said that all windows were being replaced in this financial year. This includes both kitchen windows, which can’t be opened preventing ventilation, unless the back door is opened.
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 18 The manager also reported that a budget was in place in this financial year to make other repairs including to the uneven patio and improving the wood and paintwork to the front of the house. Aspects of the kitchen are deteriorating and include two cupboard doors that don’t shut and two drawers difficult to open. A damaged worktop increases the risk of infection control. It was advised to address these matters also. Infection control was briefly discussed with a member of who confirmed that the staff are provided with a weekly budget for cleaning materials and that general supplies are also provided including equipment for managing infection control. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 19 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): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a supported, trained and caring staff group recruited through thorough procedures however the home must hold records for all persons staff working in the home. EVIDENCE: The member of staff working at the time of the inspection showed a caring attitude towards residents and offered support in a calm friendly manner demonstrating a clear understanding of her role. Residents said that they liked the staff at the home. A care professional that visits the home said that staff usually demonstrate they have the right skills to meet individual needs. There is sufficient written evidence in the home to support the staff’s comment that supervision and staff meetings are now occurring regularly. The manager said in the AQAA that there had been a dip in the staff training and staff were not up to date in all areas but this was now being addressed. Written evidence supported this and plans are in place to update staff in areas that the organisation considers mandatory
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 20 such as adult protection and moving and handling. There was also evidence of staff training taking place in the last six months such as in moving and handling and fire matters. The manager said that new staff had not been recruited to the home since the last inspection visit when recruitment records were found to be satisfactory. However, staff from another home and from the Trust’s domiciliary care service also provide care in the home from time to time but no records for these staff are held at the home. If full records are not held at the home this must be by agreement with CSCI but the manager was not aware of any such agreement in place. A requirement has therefore been made about this at the end of this report. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 21 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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are benefiting from the appointment of a new registered manager providing more consistent management of the home leading to better quality assurance and attention to health and safety matters. EVIDENCE: At the last inspection it was noted that the home had not employed a registered manager since August 2006 and there was not enough information to demonstrate how much management support was being provided to staff. A manager was recruited to the home in February 2007 and her registration with CSCI has been completed. The current manager has the appropriate NVQ level 4 in care and the Registered Manager’s Award. Management time in the home is documented and the requirement made in the last inspection report to ensure that adequate management hours in the home meet residents’ needs
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 22 has been met. The manager is employed for 28 hours a week but only 17 are for management tasks. However, the manager is currently making progress in improving the standards of the service although management hours must be kept under review as the service develops. Policies and procedures in the home were not up to date at the last inspection as many of them are now computerised and without a computer staff and management did not have direct access. At this inspection it was noted that the home has been provided with a computer with internet access although not all staff have yet been given full access. A member of staff was therefore not able to find the admissions policy but confirmed that full access was to be given following forthcoming training. The Responsible Individual has subsequently stated that all staff have access to the website and that a copy of the policy is in the home. At the last inspection quality was discussed and the area for improvement identified in the body of the report was a need for more consistent management monitoring and review within the home. At this inspection there was evidence that this was taking place. The manager mentioned staff meetings and supervision health and safety checks, residents meetings and a staff members comments and written evidence was in place to support that these were taking place. The manager was also fully aware of the environmental issues to be addressed and gave details of how this would happen. As stated in the section on individual needs and choices there was clear evidence of recent reviews of care plans and risks to people living in the home. In the last inspection report requirements were made about risk assessments and servicing of fire equipment. Comments were also made in the body of the report about inconsistent fire training. At this inspection there was sufficient written information to demonstrate that progress had been made. The household risk assessment had been reviewed as had risk assessments relating individual service users and fire evacuation. The manager was advised to ensure that the newly assessed risks the uneven patio posed to people living in the home should also be recorded to ensure that staff had consistent guidance for people with impaired vision. Other aspects of health and safety were checked. A member of staff is responsible to carry out a health and safety check on the home each month and report concerns. Documentation was in the home to demonstrate that this had been done and the member of staff confirmed that issues had been reported. The manager was aware of the findings and was taking action to have matters rectified, some are outlined in the environment section of this report. Samples of checks of fire equipment were in place and the manager said that staff had received fire training, which had been recorded on the computerised documentation for staff training. There is evidence of the manager considering training for staff in health and safety matters and in the
3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 23 three of the four files sample staff had received training in moving and handling in May 2007 and plans were in place for the other person to be trained. 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 24 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 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 3 x 3 x 3 x x 3 x 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 25 no 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 YA34 Regulation 19 schedule 2 Requirement Records of pre employment checks must be held for all staff providing care in the home to offer full protection to people using the service Timescale for action 25/10/07 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 3 Tensing Close DS0000067323.V338771.R01.S.doc Version 5.2 Page 26 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
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