Inspection on 09/01/07 for 3 Tensing Close

This inspection was carried out on 9th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Tensing Close 11/09/07

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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 3 Tensing Close Fareham Hampshire PO16 7QE Lead Inspector Ms Sue Kinch Unannounced Inspection 9th January 2007 11:00 3 Tensing Close DS0000067323.V323456.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.V323456.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.V323456.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), Learning disability over registration, with number 65 years of age (3) of places 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection First inspection with this provider. 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, laid to lawn with fruit trees and a greenhouse. Hampshire Partnership NHS Trust manage 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.V323456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the home this year and all key standards were assessed. It was unannounced and was completed by one inspector over 6 hours. Three residents, three staff members, a team manager and service manager contributed on the day of the visit. A telephone discussion was also held with the line manager to the home after the inspection. Care practices were observed. A partial tour of the home was made with some of the residents. The shared areas and all bedrooms were seen. Some of the homes records and policies and procedures were also viewed. Information was also obtained by reviewing the service file held by CSCI. Immediate action was required regarding medication. A letter was sent in respect of this following the inspection. What the service does well: What has improved since the last inspection? What they could do better: A new manager has just been recruited to start on 26th February 2007. This will benefit the residents as some elements of the service need reviewing and updating such as risk assessments, assessments and care plans. These had been updated more regularly when the previous registered manager was in post. There has been some management input to the home but some standards have slipped. Attention is also needed to ensure that medication procedures are fully followed 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 3 Tensing Close DS0000067323.V323456.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.V323456.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. Residents needs are assessed and they can visit the service before they move in. EVIDENCE: A new resident had recently been admitted and written information giving details of the initial care needs to be met was at the home. A member of staff had started a full re-assessment, which will lead to full care plans. Initial guidance was in place. Records in the home included a copy of the care manager’s assessment and were obtained as part of the pre –admission process. The resident had been able to visit the home before moving in, although this had been a shorter process than usual due to individual circumstances. A member of the management and some staff had also visited the resident. The resident agreed that questions about support needed had been asked before moving in and support needed was being received. One staff member spoken with about the admission was aware of the records available and had read the information relevant to the support needed. The member of staff was also able 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 9 to highlight some of the specific needs of the resident and was addressing them during the inspection. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents will benefit from the planned review of assessments and care plans and from risk assessments covering a broader range of issues. EVIDENCE: There are three sets of care plans although for one person the support needed had yet to be elaborated upon in the care planning system for the home. However staff felt that they had enough information to support the resident in the interim and demonstrated knowledge of main needs. The residents all said that they did receive the support needed from the staff. The two developed set of care plans have been reviewed less regularly since the registered manager left. Some had not been reviewed since March and May 2006 although a review of care for one person had taken place in November 2006. However several of the issues that support is needed for were discussed with residents and staff during the inspection were recorded in the care plans. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 11 Staff felt that reviews of care plans were needed and a member of staff named the staff identified to do this and said that work had started. Some risk issues are addressed in the care plans but more work is needed in this area so that issues like hot radiators and water are risk assessed for individuals where necessary. Support to minimise risks to residents in the community were covered for one person in care plans but not for the others although all need support with this. Support to make decisions about long-term plans and day-to-day issues, is given by the staff. Examples were noted in individual discussions with residents, and in group discussions with residents and staff. This included decisions about social activities, when to eat, what to eat and daily routines. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 12 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 do with respectful support from staff. 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: Residents are supported to attend day services and local groups in the community and also use other facilities. Things that they like doing were discussed with individuals and in a group with a staff member. A range of activities and interests were discussed and residents confirmed that they did get to do things that they enjoy in and out of the home. At times additional 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 13 staff members are brought in for specific shifts so that enough are available to support residents in the community. A car had been provided to the home for such purposes and residents talked of going to the pub, out for meals, shopping and for walks. One resident was looking forward to being involved in the gardening and was confident that would happen. Support is given to assist social and relationship issues. Evidence of this was noted when observing staff approaches to service users during the inspection. One particular issue about maintaining personal social space was recorded in one of the care plans and staff were following the guidance. Another resident was being talked with about a particular relationship issue. Residents like the food that is provided in the home and said that they did have their favourite foods sometimes. 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 that other options can be chosen when shopping. The staff member said that menus are discussed regularly so that residents know what is for meals. However, use of a pictorial menu could be used at the home. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain good health and receive personal care. Residents would be less at risk if medication was held securely and any selfmedication is preceded by a risk assessment. EVIDENCE: Staff members provide residents with help and assistance with personal care and health needs. Evidence of this was apparent in discussions with residents individually and with staff. A sample of records of health needs and visits to appointments were viewed in two files checked and corresponded with some of the verbal information given. Health professionals are involved in meeting residents needs. A detailed record was held in the care plan sampled. The staff member spoken with about this is involved in taking residents to appointments and was aware of the health needs of the current residents. Not all elements of the medication system sampled were correct. The record of administration checked had been fully completed, but not all drugs were stored securely. In one bedroom the inhalers and some tablets were placed on the 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 15 chest of drawers. There was sufficient evidence to demonstrate that, in another room the drawer containing tablets in a monitored dosage system had not been locked since the morning. Neither resident had a bedroom key. This exposed residents to risk. Risk assessments for administration of medication indicating that the residents were responsible were not found in their files. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 16 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: There is a complaints procedure for the home which staff are expected by management to talk through with residents. The procedure does include some pictures to aid understanding. These are kept in the residents files in the office. The one resident asked said that they were not aware of the complaints procedure. Consideration could be given to making a copy available to residents so that they do not have to only access it through staff. The management agreed to address this. Friendly and caring approaches to residents were noted. Talking about problems and complaints was discussed with two residents who said they would talk to staff if they had any. A complaints log is in the home and the last complaint was followed up. Complaints are monitored in the monthly regulation 26 visits. Adult protection was discussed and a member of staff and the Responsible Individual referred to an ongoing issue, which had been appropriately referred to social services who were dealing with it under adult protection procedures. Elements of a protection plan were being planned for implementation. Advice was given to report such matters to the Commission at an earlier stage. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 17 Adult protection training was discussed with a member of staff, the Responsible Individual and a team manager. Records indicate that some training has been received in the past by staff and the team manager said that elements of it are included in induction for staff. One member of staff had received training in January 07 and another was planned to do it in February 2007. Training had been cancelled for other staff in late 2006 and was to be re planned. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The environment is monitored and issues are addressed to ensure that residents are provided with pleasant and hygienic surroundings. EVIDENCE: The service users like the home and find it comfortable. The internal décor is pleasant and mostly adequately maintained although the paintwork of one bedroom window is in need of attention. The home is clean and provided with comfortable furnishings. The external presentation of the home has deteriorated and looks unkempt with flaking paintwork. Staff and management said that negotiations were underway to address this. There was evidence of other maintenance work recently completed. Each bedroom is individualised with evidence of needs such as safety and personal preferences being taken into account. None of the rooms have ensuite facilities although one has a hand washbasin. The home has one bathroom 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 19 witha toilet and a separate WC. The needs of residents continue to be monitored to ensure that existing arrangements are sufficient to meet their needs and maximise infection control. The line manager to the home said that this would be considered in the review of risk assessments referred to in the section below on management. The home is clean and the toilet and bathroom areas were adequately supplied with washing and cleaning products for infection control. Yellow sacks are used for clinical waste but a bin was needed in one of the bedrooms. Staff member said that this was being purchased by the end of the week. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 20 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 good. 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. EVIDENCE: Staff members are encouraged to take part in training. The organisation has an overall training calendar for the year, which offers opportunities for staff to complete courses seen by the management as mandatory. These include medication, moving and handling, first aid, food hygiene health and safety. Records are kept in the home of the training that staff have done. The management, external to the home, through regulation 26 reports, monitors this. The line manager said that any updates needed had been planned for 2007. A staff member confirmed that training needed by staff is discussed in supervision and planned as needed. The staff member also said that other training can also be provided as identified based on the needs of the residents in the home and sighted an example of this. Despite limited management time provided at the home in the past 4 months staff said that the staffing levels in the home have been maintained and have 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 21 been adequate to meet the needs of the residents and this has continued since the admission of another resident. Staff showed the inspector the rota, which showed that at times there is only one member of staff in the home. Staff said that they were still able to meet the needs of residents and they are able to have additional staff at times in order to meet needs. Rotas supported this. Staff records are held in the home although these were not accessible at the time of the inspection. However one of the managers brought copies from the office and the appropriate records for the newest member of staff had been obtained. 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users would benefit from consistent management of the home increasing monitoring and action to ensure that quality is maintained and health and safety fully assured. EVIDENCE: The home has not had a registered manager since August 2006. Staff said that management support has been provided one day a week from a manager of another registered home and another from the line manager to the home. There was not enough information to demonstrate how much management support had been provided to staff. Staff however said that support and supervision had been received and they could contact the local office for help as needed. They felt that management was supportive. There was evidence of this during the inspection. A manager has been recruited to the home and will 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 23 be starting at the end of February. In the meantime clearer documentation of management input into the home is needed. Policies and procedures in the home are not up to date as many of them are now computerised and without a computer staff and management do not yet have direct access. The line manager to the home said that the installation is in hand. In discussion about quality a Hampshire Partnership NHS Trust manager assisting with the inspection said that the Trust does regularly review it’s services and the result of consumer consultation for 2006 was being assessed. Team reviews are carried out quarterly and focus on the management and staff achievements. Regulation 26 visits monitor the service and have been carried out. The manager said that three specific objectives set for 3 Tensing Close and a copy of these was provided. To demonstrate that these objectives are being met more consistent management monitoring and review within the home is needed. Elements of action taken regarding health and safety at the home were assessed and gaps were found indicating a needed for more management. The homes risk assessments are due for review and those sampled should have been reviewed in late December 2006. The control for one risk assessment was not in place but was in place for another risk assessment considered. The fire risk assessment should have been reviewed in November 2006 as identified on the form. In house weekly alarm system checks are completed inconsistently although the annual specialist check had been done. The last specialist check of the fire system had been completed within the right timescale but in house checks of the fire equipment were not carried out monthly. Staff training in fire matters was been carried out more consistently in the first part of 2006 and were in need of attention. 3 Tensing Close DS0000067323.V323456.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 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 2 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 1 x 2 x 2 x x 2 x 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 25 N/A 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 YA9 Regulation 12 (4)(c) Requirement The registered persons must ensure that all risks to individual residents are assessed, controls are in place and this is regularly monitored. The registered person must ensure that residents are protected with medication being securely held at all times. The registered person must ensure that adequate management hours are provided to meet the needs of service users. The registered person must ensure that risks to residents are assessed, reviewed and minimised by ensuring that adequate controls are in place. The registered person must ensure that servicing fire and any other equipment is completed routinely within required timescales. Timescale for action 04/03/07 2 YA20 12, 13(2) 09/01/07 3 YA37 24 04/03/07 4 YA42 12, 13 (4) 04/03/07 5 YA42 12 13 04/03/07 3 Tensing Close DS0000067323.V323456.R01.S.doc Version 5.2 Page 26 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.V323456.R01.S.doc Version 5.2 Page 27 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. 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