Inspection on 26/07/05 for 35 West Thorpe

This inspection was carried out on 26th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

35 West Thorpe 10/10/08

35 West Thorpe 17/10/06

35 West Thorpe 07/01/06

35 West Thorpe 31/03/05

35 West Thorpe 28/06/04

35 West Thorpe 27/01/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 West Thorpe (35) 35 West Thorpe Basildon Essex SS14 1LX Lead Inspector Nicola Dowling Unannounced 26th July 2005 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. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service West Thorpe (35) Address 35 West Thorpe Basildon Essex SS2 5TE 01268 285788 01268 285788 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) Estuary Housing Association Limited Mrs Maureen Lawrence CRH Care Home 3 Category(ies) of MD Mental Disorder (3) registration, with number of places West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Care and accommodation to be provided to no more than three service users. 2 Care and accommodation to be provided to three service users with mental disorder excluding learning disability or dementia. Date of last inspection 31st March 2005 Brief Description of the Service: West Thorpe is a care home for three residents with mental health problems. It is located within walking distance of Basildon town centre and forms part of a residential estate. Basildon council own the property The house is domestic in size; there is a communal lounge, a kitchen with a dining area and a conservatory which is used a smoking area. Each resident has a single room. There is a well maintaintained garden to the rear of the property with a patio area. The home is near to local shops, facilities and public transport. The home has a car for the use of the residents. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. The inspection consisted of a tour of the home, talking with staff, visitors and residents, observing the care given, and reading of documents. As there were no relatives at the home during the inspection their views have not contributed to this inspection report. The home is a normal domestic style house and had a warm atmosphere. One resident went out to work independently; another was collected for work and one resident stayed at home. All residents said that they were generally happy with the home and the way staff cared for them. The home is currently full. What the service does well: The care provided by the staff is good and the home is able to provide a normal life style for the residents, this helps them to maintain as much independence as possible. Through the week two of the residents attend work activities in the community. The resident that stays in the home helps the staff with jobs in the house and will go out with staff to run errands or do the shopping. Each resident has their own room that has their own belongings in it. For example; computers, DVD players and TVs. Staff allow the residents to have time on their own and one resident said that the staff are “kind”. When residents get up in the morning they make their own drinks and breakfast. The staff cook evening meals and the residents said the food was good. One visitor to the home described the residents having a good life at the home. Estuary Housing Association have developed a residents’ feedback system called the Quality Network Review. This system is about finding out what residents’ think of the homes’ they live in and the life-style that they lead. As a result of this survey one of the improvements was to give residents an outing once a month. West Thorpe has started fulfilling this request and the residents have been out on various day trips, as well as an annual holiday to Spain. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 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. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 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 West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 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 To make sure that the home can meet residents’ needs a full assessment that involves their family and other professionals is undertaken. EVIDENCE: There have not been any new residents admitted to the home since the last inspection. Estuary Housing Association have a written policy and guidelines to follow when a new resident is admitted. The written records show that the procedure was followed properly when the last resident was admitted, this was over a year ago. The two other residents have been in the home for the past nine years and there is no plan to change their placement. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 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 and 9 The care that is provided to the residents is good and takes into account restrictions on some daily living skills to make sure the residents stay safe. EVIDENCE: The residents were able to talk about their care plans and there was written evidence that they had participated in the care planning process. Restrictions on tea and coffee have been put into place on advice from the residents GP. The care plans were well written and provided a good guide on the type of care the residents needed. All the care plans were followed by a risk assessment to ensure the resident undertook activities with safety. The care files were organised and the daily care notes evidenced that the care plans were being followed. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 16 and 17 The residents have a good lifestyle with varied activities and good food. EVIDENCE: Two of the residents go out to various work places through the week. A regular visitor to the home who comes to collect one of the residents for work described the home as good and that the residents have a “good lifestyle”. One resident stays at the home and has a worker visit from the local rehabilitation centre once a week. Day care has been tried for this resident but was unsuccessful, therefore the home engage him in jobs around the home to maintain life-skills and activities of daily living. The residents go out on various day trips. Over the past two months they have been to the seaside at Ramsgate, Party in the Park at Southend and trips to the pub. They have also had an annual holiday to Spain. There are photographs around the home of their trips out, however the residents said that they are happy to stay at home and not go out too much! The residents said that the food was good and that there was enough for them to eat. The menu’s evidenced a varied diet with a cooked meal and a desert everyday. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 11 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) 20 Medication is safely administered in the home. EVIDENCE: One resident controls his own medication and maintains the records for this task. Other medication administered in the home was stored correctly and recorded properly. There is access to drug information and the homes’ drug policy is kept with the medicines. There is a record of when depot injections are given and the home have a yearly visit from a local pharmacist for audit purposes. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 12 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 Satisfactory arrangements are in place for the protection of the service users, however there is a risk of vandalism to cars parked at the rear of the property. EVIDENCE: Staff spoken with understood abuse and are due to undertake training on this topic. From the staff records there was evidence that other staff had undertaken training on this subject. There is an Estuary Housing Association policy on abuse and the home manager also has the guidance from the Essex Vulnerable Adults Committee on what to do if abuse is suspected. There have not been any complaints about the home. The incidents reported are all about vandalism to staff cars. There is a service road at the back of the house and this is where staff and visitors can park their cars. Cars parked here have been vandalised for example wing mirrors broken. Planning for a driveway has been granted however as yet there are no plans in place to build one. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 13 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 and 30 The home provides a safe, warm and comfortable living environment. EVIDENCE: The premises are safe, comfortable, bright, clean and cheerful and free from offensive odours. The home offers a warm and comfortable environment for the residents. The lounge has been redecorated and contains new settees that were comfortable. New blinds were in the conservatory where the residents go to smoke. These blinds help to provide shade, as the conservatory can be very hot in the summer months. One resident has had his bedroom redecorated and has new furniture, which he was pleased with. There is a domestic washing machine in the kitchen as this is what suits the need of the home. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 14 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) 34 and 35 Staff have training relevant to the care needs of the residents however incomplete staff recruitment records leave residents potentially at risk. EVIDENCE: Staff spoken with had received training in first aid, adult protection, food hygiene and mental health awareness. Fire training is due, however staff and residents knew what to do in the event of a fire. Some staff have completed the National Vocation Qualification in care. Staff spoken with were enthusiastic about training. During the inspection a home manager from a different home came to the house to do a video with the residents. This video is for the purpose of training staff. The recruitment records for a new member of staff were checked and were satisfactory. Original Police checks were also available for all staff, however other records were missing such as, a recent photo and proof of identity. The recruitment practice at the home is not robust enough to ensure the residents safety. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 15 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) 39 and 42 The home is well managed and reviews its performance through self-review that includes seeking the views of residents. EVIDENCE: Health and safety is well managed in the home and was recently commented on in a health and safety report. A random selection of safety certificates was sampled and these were all up to date. The testing of fire equipment is due for renewal and the home manager was waiting for a date regarding this. This year one of the residents is taking part in the quality network review for Estuary Housing Association. This is part of the residents’ feedback system and involves finding out what residents think of the home they live in and the lifestyle that they lead. The surveys do not identify areas that need improvement. There is a monthly residents’ meeting to discuss and get the residents views about matters in the home. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 16 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 West Thorpe (35) Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 17 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 34 Regulation schedule 2(1) Requirement The registered person must ensure a robust recruitment policy that includes proof of a persons identity and a recent photograph. Timescale of 31.07.05 not met. Timescale for action 12.09.05 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 24 24 42 Good Practice Recommendations The registered person should establish if a driveway is to be built for the property The registered person should maintain contact with the council regarding the windows that need replacing. The registered person should ensure that the fire equipment checks are rebooked. West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea SS2 6BG 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. Extracts may not be used or reproduced without the express permission of CSCI West Thorpe (35) I56-I06 S18083 West Thorpe V241142 260705 Stage 4.doc Version 1.40 Page 19 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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