CARE HOME ADULTS 18-65
38 Den Hill 38 Den Hill Eastbourne East Sussex BN20 8SZ Lead Inspector
Lucy Green Unannounced Inspection 25th January 2006 4:30 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 38 Den Hill Address 38 Den Hill Eastbourne East Sussex BN20 8SZ 01323 646282 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) Autism and Aspergers Care Services Ltd Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That only service users diagnosed as Autistic or having Aspergers Syndrome will be accommodated. 15th July 2005 Date of last inspection Brief Description of the Service: 38 Den Hill is a semi-detached home located in the Old Town area of Eastbourne. The home is registered to provide residence and support to three younger adults with Aspergers Syndrome. The home is owned by Autism & Aspergers Care Services. The service is accredited by the National Autistic Society and the home is also monitored by this agency to ensure specific standards are maintained. Each resident has their own single bedroom and access to a range of communal areas. One bedroom has en-suite facilities and the home has one bathroom which is accessed by residents and staff. The home has a well maintained garden to the rear of the property. The home seeks to promote autonomy and choice and residents are encouraged to work towards achieving independent living. Residents are supported to access a range of educational, vocational and leisure activities as appropriate. At the time of the inspection two residents were living at 38 Den Hill. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 38 Den Hill are referred to as ‘residents’. This unannounced inspection took place over two hours during the evening of 01 March 2006. This is the second inspection of this financial year and therefore this report should be read in conjunction with the report from the announced inspection carried out on 15 July 2005. The purpose of this inspection was to meet with residents and staff and to generally monitor care practices at the home. The Inspector observed one resident prepare the evening meal and joined all three residents in the dining room whilst they ate. In addition, a partial tour of the premises took place and two care plans were viewed. The Deputy Manager who was on duty was spoken with throughout the inspection. What the service does well:
The home offers a specialist service to younger adults with Aspergers and both the management team and staff have the necessary skills and experience to deliver this service well. In addition to inspections by the Commission for Social Care Inspection, the home is also accredited and monitored by the National Autistic Society. 38 Den Hill, is a service which runs in parallel to the other home owned by Autism and Aspergers Care Services, 53 Percival Road. The home has received consistently good reports on the services provided since it was first registered three and a half years ago. This inspection again reflects the high quality of service provided to the people who live at the home. The home enables residents to develop new skills and work towards achieving independence. Each resident is involved in preparing a plan of care which outlines how they like and need to be supported. These documents are very detailed, whilst still being easy to read. A new resident has moved into the home since the last inspection and the admission process was very thorough and individually tailored to meet this individual’s needs. Residents are supported to be fully involved in the running of the home and at the time of the inspection, one resident prepared and serviced the evening meal.
38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 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. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These key standards were not assessed on this occasion, please refer to the report from the announced inspection carried out on 15 July 2005. EVIDENCE: 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&7 Residents continue to benefit from a care plan that both enables and protects them. Residents are fully involved in all decisions that affect their lives. EVIDENCE: The Inspector viewed the care plans in place for one existing resident and the resident who has recently moved into the service. The system of care planning at 38 Den Hill continues to comprehensively outline care needs in an accessible way. The Inspector is again impressed with the objective and goal focused approach to the way care plans are constructed. The care plans identify individual goals for each resident to enable them to achieve maximum independence and develop their skills. Each goal is backed up by a training plan which explains how staff should support residents in order to achieve that goal. Goals are monitored and discussed regularly with the resident and reviewed formally at least every six months. A full care review is held at least once every six months, with interim mini reviews in-house. Minutes from these meetings were viewed and found to be
38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 10 detailed and focused. It was pleasing to note that staff were vigilant to changing needs and that appropriate action had been taken to revise risk assessments and support plans. Evidence gathered from documentation and observation of staff supporting a resident, highlighted that the home continue to provide a service where residents are encouraged and supported to lead independent lives. It was noted that where rights had to be limited for the well-being of residents these were fully agreed with residents and ‘behaviour contracts’ had been compiled and agreed by all parties. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 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 the following standard(s): 16 Residents benefit from a placement where their rights and responsibilities are fully recognised. EVIDENCE: 38 Den Hill is a service which supports people to achieve maximum independence. Through the process of careful risk assessment and training, residents are enabled to hold their own front door key, stay alone in the home for agreed periods of time and access the community and services independently. As a responsibility of living in shared accommodation, residents are expected to undertake identified household tasks on a rota basis. A copy of the rota was found on display in the kitchen. One resident was observed preparing and serving the evening meal. A photographic recipe book has been complied to support residents to cook meals. Residents meetings are held each week to discuss house issues and residents and staff have formed a list of ‘house rules’ to ensure all parties respect each other and their wishes.
38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Residents are protected by the systems in place to manage medication. EVIDENCE: The storage and administration of medication were found to be satisfactory. Records are accurate and current. At the time of the inspection, only minimal medication was being held. Staff receive appropriate training in the management of medication and undertake a comprehensive competency test – copies of completed work books were found in staff files. The home prepares residents to manage their own medication within a risk assessment framework. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These key standards were not assessed on this occasion, please refer to the report from the announced inspection carried out on 15 July 2005. EVIDENCE: 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents benefit from a homely, safe and comfortable environment. EVIDENCE: 38 Den Hill is an attractive semi-detached house which is situated in the Old Town area of Eastbourne, a short walk from local shops and public transport links. The home is pleasantly decorated and well-maintained both internally and externally. The home comprises of three single bedrooms and an office/sleep-in room. The lounge and dining room provide residents with sufficient communal space to meet their needs. Residents have access to a garden at the rear of the property. Residents are supported to take responsibility for keep the home clean and tidy and this was found to be the case at the time of the inspection. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 Residents benefit from an experienced and dedicated team of staff who know how to support them effectively. EVIDENCE: At the time of the inspection, the home had one support worker vacancy and the Deputy Manager has been covering these hours. Therefore , at this time Den Hill is being run by a team of three people. Discussion with the Deputy Manager and examination of staff files, identified that staff training is continuing. There was documentary evidence that staff had completed an induction programme in line with Skills for Care. Staff have undertaken courses in fire safety, food hygiene, care management, protection of vulnerable adults and medication. There was evidence that on completion of the induction and mandatory training courses, staff commence National Vocational Qualifications. Staff also complete a wealth of specialist training in supporting people with Aspergers’ Syndrome. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 39 Residents benefit from living in a well run home that has effective systems in place to self-audit and improve. EVIDENCE: At the time of the inspection, the position of Registered Manager was vacant. The Deputy Manager has been leading the service under the guidance of the General Manager for the past seven months. There was again evidence that the home is being well managed and that the management arrangements are working effectively for all parties. The Deputy Manager reported that she is currently completing National Vocational Qualification Level 4 in care and will then commence the Registered Managers’ Award. It is anticipated that this person will be put forward for registration in due course. Staff at 38 Den Hill have always worked as a close team and this is again reflected in the quality of service. Through observation, it was evident that residents have a good rapport with the staff who support them.
38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 17 The home has a number of systems in place to self-audit. These include daily handovers for staff and regular team meetings. The supervision records inspected highlighted that staff are able to provide constructive feedback to their supervisor about what is working well and those areas that could be improved. Residents meetings are held each week and minutes are recorded. Relatives are given both formal and informal opportunities to provide feedback on the service. The Registered Provider conducts monthly monitoring visits in line with Regulation 26 and supplies copies of these reports to the CSCI. The home is also accredited by the National Autistic Society who assess the quality of service each year. 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 X 23 X 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 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 4 X 3 X 3 X X X X 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 38 Den Hill DS0000040498.V276544.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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