Inspection on 13/01/06 for 4 Vallance Gardens

This inspection was carried out on 13th January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Vallance Gardens 21/03/07

4 Vallance Gardens 26/07/05

4 Vallance Gardens 11/01/05

4 Vallance Gardens 13/07/04

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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 4 Vallance Gardens Hove East Sussex BN3 2DD Lead Inspector Jennie Williams Unannounced Inspection 13th January 2006 10:15 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 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 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 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. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 4 Vallance Gardens Address Hove East Sussex BN3 2DD 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) 01273 749626 Care Management Group Limited Mrs Sharon Lesley Lacey Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That service users are aged between 25 and 65 years upon their admission The maximum service users to be accommodated is 10. That the category of service users admitted have a learning disability, not falling within any other category That one service user, who is over the age of sixty-five(65) years at the time of admission but who otherwise falls within the main category may be accommodated 26th July 2005 Date of last inspection Brief Description of the Service: 4 Vallance Gardens is one of many homes owned by Care Management Group Ltd (CMG). 4 Vallance Gardens is registered to provide accommodation for ten residents with learning disabilities. There are eight single rooms and one double room. All rooms are currently being used for single occupancy. Rooms are located over two floors. There is a stair lift available to assist residents to access the first landing, then six steps that must be negotiated independently to access the first floor. The home is located in a quiet residential area of Hove. Local amenities and the seafront are within walking distance of the home. There is nearby access to public bus routes. There is no parking available at the home. Paid parking is available in adjacent streets and also available at the nearby leisure centre. The home has accessed visitor permits for relatives coming to visit from out of town to enable them easy parking. The home has access to its own transport. Residents are provided with an opportunity to attend a day centre. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours on the 13 January 2006. Staff files, some policies and procedures, records, individual personal allowances and medication procedures were inspected. A random selection of care plans were spot-checked. Staff were spoken with throughout the inspection process. There were nine residents residing at the home. Some residents were spoken with, although limited conversation took place due to the communication needs of some individuals. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection report of 26 July 2005. What the service does well: 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. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 6 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 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 7 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): 1&5 The home has information available to prospective residents and their representatives to make an informed decision if the home is suitable for their needs. EVIDENCE: The Statement of Purpose and Service User Guide were not inspected on this occasion. The manager is aware that these documents require updating upon completion of the building works. It is required that a copy of these reviewed documents be forwarded to CSCI upon completion. The organisation has a central assessment team based in Wimbledon who undertakes the initial assessment of prospective residents. A senior person from the home will also be involved in the assessing process. There have been no new admissions since the last inspection as all rooms are now being used for single occupancy. Prospective residents/representatives are encouraged to visit the home prior to moving in. Due to the disability of the residents, admissions are generally well planned and the home will not take any emergency referrals or short-term admissions. Social services have their own contract with the organisation for the residents they are purchasing care for. Head office of CMG deals with all contracts. It is required that a copy of the contract is kept within an individuals file and available for inspection. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 8 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&9 Care plans provide good guidance for staff on the needs of the individuals, however some needs are at risk of not being met due to the lack of updating care plans when the need of an individual changes. EVIDENCE: Care plans were only spot-checked on this occasion. One care plan inspected had not been amended to reflect important changes within an individuals’ health needs. The home must ensure that care plans are amended to reflect changes within an individual’s assessed needs when identified and reflect current practice. All residents have daily diaries that are kept with the individual. Keeping the daily diaries with the individual encourages good communication between the home care staff and the day centre staff and promotes continuity of care. The notes recorded in these have improved as required in the last inspection report. CMG are have developed a new Health Booklet that will include information on an individual. These will be incorporated into residents’ personal files. It was confirmed that they will contain comprehensive information on an individuals’ health needs. Staff will be provided with training on using these new formats. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 9 Risk assessments have been implemented and expanded as required from the last inspection. It was discussed with the manager the importance of having risk assessments in place regarding door locks to an individuals’ room. Clear evidence needs to be provided why it is or isn’t suitable for an individual to have door locks to their bedrooms. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 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 the following standard(s): 11, 13, 16 & 17 Residents are provided with opportunities for personal development and to be involved in the local community. Visitors are welcomed at the home. EVIDENCE: Residents are provided with a range of activities they are able to participate in. Some individuals attend a day centre that provides opportunities for residents to engage in informative and creative activities should they wish. Due to the disability of the individuals, no one is capable of being involved in employment. The home has its own bus and there is a full time driver available. One resident is currently enjoying a gardening course at college and another is pursuing their interest in pottery. Residents have daily routines. These routines are flexible, but due to the complex needs of some individuals, residents respond better when there is a familiar routine in place. Staff are keeping clearer records of activities provided to residents as required at the last inspection. It was confirmed that three residents recently attended a Holiday on Ice show and two have been to see a pantomime. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 11 Visitors are welcomed at the home. Residents may see visitors in their own rooms if they wish. There is a visitor’s book kept at the entrance of the home that all people must sign when entering and leaving the home. Residents were observed to be enjoying their lunch. Staff are present to provide discreet assistance when required. The manager confirmed that there are plans to change the kitchen layout and consideration must be given when designing the kitchen to ensure that it is user friendly for residents. This should include enabling those in wheelchairs to be able to access work areas to assist in promoting independence. The current layout is too small and inappropriate for residents to input into the preparing and cooking of meals. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 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): 18, 19 & 20 Residents’ needs are being met by the skill mix of staff and support network of health professionals. Residents are safeguarded by the medication procedures within the home. EVIDENCE: There are guidelines kept in a separate folder from the care plans that provide guidelines for all staff on the preferred way an individual is to be moved. The home does not provide nursing care. Due to the complex needs of some residents, staff are required to have a clear understanding of all needs. Health needs are also met with the good support network from the community health specialists. It was confirmed that residents are weighed on a monthly basis and specialist advice is accessed if required, via a referral from the GP. The home has a good relationship with the community team to access speech therapists, physiotherapist and other specialist input when required. These health professionals have looked after the residents for a long time and visit the home on a regular basis. The manager confirmed that the specialist health professionals are very supportive. There is no nursing care provided at the home. District nurses will visit the home when required. There is no one capable of self-medicating at the home. MAR charts inspected demonstrated that medication was being signed for at the time of 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 13 administration. All staff that administer medication have been trained and assessed as being competent. Some staff have undertaken a twelve-week medication course through college. It is recommended that better lighting be provided for the medication area. The manager confirmed that they are continuing to obtain information on the wishes of an individual following death. Some family members do not wish to discuss this issue and the home is liaising with the care managers of the individuals. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents/representatives are provided with opportunities to air their views. EVIDENCE: There have been no complaints made to the home or directly to CSCI since the last inspection. There is a complaints procedure available at the home and a pictorial complaints procedure implemented for residents. The manager confirmed that some senior staff attended training on adult protection in December 2005 that was facilitated by the Brighton and Hove Council. Staff also receive adult protection training provided by the CMG organisation. The manager also tries to access adult protection training through courses run by the local authority. Policies and procedures for complaints and adult protection have been amended locally. It was confirmed that the whistle blowing policy has not been amended as required at the last inspection. The home is awaiting the amended documents from head office. Residents’ monies spot-checked demonstrated there are suitable procedures in place for dealing with personal finances. Receipts are kept and clear records are maintained. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Residents will benefit from a more homely environment when the building works are completed. Residents are unable to access all areas of the home unless they are physically independent to negotiate the stairs. EVIDENCE: The home is located in a quiet residential area of Hove. Local amenities and the seafront are within walking distance of the home. There is nearby access to public bus routes. There is no parking available at the home. Paid parking is available in adjacent streets. The home has accessed visitor permits for relatives coming to visit from out of town to enable them easy parking. The home has access to its own transport. There are eight single rooms and one double room. All rooms are now being used for single occupancy. Rooms are located over two floors. There is a stair lift available to assist residents to access the first landing, then six steps that must be negotiated independently to access the first floor. The garage, adjacent to the lounge/dining room is currently being converted into additional lounge space. This will increase the communal area available, which will benefit all residents. There are plans to change the layout of the kitchen, see the ‘Lifestyle’ section of the report for additional information. The 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 16 manager confirmed that this additional space will allow for a sensory room to be developed. Rooms spot-checked were seen to be personalised to reflect the individuals’ choice and character. There are toilet facilities for staff located on the second floor. It was confirmed that these are now used by staff and not the en suite facility provided on the ground floor for a resident. This is a requirement met from the last inspection. The laundry has been relocated to another area within the home. The small room is used purely for laundering purposes. The washing machine now has a sluice cycle available. This outstanding requirement has now been met. As part of the refurbishment programmed, priority should be given to changing the carpets that are in communal areas. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 17 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): 31, 32, 34 & 36 Residents’ needs are being met by the number and skill mix of staff on duty. Residents are safeguarded by the robust recruitment procedures in place. EVIDENCE: Staff spoken with during the inspection process were happy working at the home. Staff were complimentary about the manager of the home and find her approachable. Staff spoken with confirmed that staffing levels have generally improved as required at the last inspection. Staff felt that all residents are appropriately placed and needs are being met. The home is currently recruiting for new staff. The home does not have the recommended number of staff NVQ level 2 or equivalent qualified, but it was confirmed that steps have been implemented to achieve the 50 ratio of trained staff. Two staff have left employment at the home that were NVQ trained. There is one staff member that has achieved NVQ level 3 and another currently completing this qualification. Three staff are currently undertaking NVQ level 2 studies and an additional three will be commencing this course in the next couple of months. One member of staff is undertaking an apprenticeship and NVQ level 2 is incorporated into the package. The 50 ratio of NVQ qualified staff has been reduced to a recommendation, as there is evidence that the home is working towards this target. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 18 Staff confirmed that they are provided with opportunities to attend training and are kept up to date with all mandatory training. Head office of the CMG organisation arranges the training schedule and sends this to the home on a monthly basis. A new member of staff was spoken with who confirmed that they were provided with a good induction and staff and management were patient, approachable and very supportive. They confirmed that they were provided with terms and conditions and a job description. They were complimentary about the staff morale. Records inspected demonstrated that staff are receiving regular supervision. Staff spoken with also confirmed this. Regulation 26 reports from the head office of CMG are very detailed and regularly sent to CSCI. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 19 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 & 42 Residents and staff benefit from clear leadership within the home. Residents are safe guarded by the systems in place to monitor the health, safety and welfare of residents. EVIDENCE: The manager is registered with CSCI and has relevant experience to manage the home. Staff spoken with found management approachable. The manager has been unable to complete the Registered Manager Award (RMA) due to the lack of assessors available. She plans to undertake NVQ level 4 in care on completion of the RMA. CMG head office send out their own quality assurance documentation to residents families/representatives. Head office provides the home with feedback. It is recommended that the home obtain written feedback from visiting health professionals as part of their quality monitoring system. There is a checklist for undertaking an inventory of residents’ belongings on admission. It was confirmed that inventories of personal belongings have not been completed, but all new ones will be undertaken following the Christmas period. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 20 The kitchen door was observed to be wedged open even though an appropriate door guard was in place. It was confirmed that the door is generally closed and the door guard is waiting to be repaired. This has not been reflected as a requirement as the home is addressing this problem. It was confirmed that all relevant health and safety checks are undertaken. A full service by a fire safety company was undertaken in November 2005 and an update in fire training is currently being arranged. 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 21 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 2 X X X 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 X 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 4 Vallance Gardens Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 3 X DS0000014142.V249614.R01.S.doc Version 5.0 Page 22 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 YA1 Regulation 4&5 Requirement That a copy of the reviewed Statement of Purpose and Service User Guide is forwarded to the CSCI upon completion of the building works. That a copy of the contract is kept within an individual’s file and available for inspection. That care plans are amended when the needs of an individual changes. Care plans must reflect actual current practice. That risk assessments be undertaken regarding the suitability of door locks on individual doors. That consideration is given when designing the new kitchen to ensure that it is user friendly and accessible for wheelchair users. That the whistle blowing policy is amended to state that it refers to any practice in the home and not just abuse issues. (Timescale 30.09.05 not met) Timescale for action 28/02/06 2. 3. YA5 YA6 17 15 28/02/06 28/02/06 4. YA9 13 (4) 28/02/06 4. YA17 16 (2)(h) 31/03/06 5. YA23 Appendix 2 28/02/06 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 23 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. 4. 5. Refer to Standard YA20 YA24 YA32 YA39 YA40 Good Practice Recommendations That better lighting be provided for the medication area. That the carpets in the communal areas are replaced. That a minimum ratio of 50 of care staff is qualified to NVQ level 2 or equivalent. That the home obtains written feedback from visiting health professionals as part of the quality monitoring system. That a quick reference guide be provided for the policies and procedure manual. (Outstanding recommendation) 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 24 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 © 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 4 Vallance Gardens DS0000014142.V249614.R01.S.doc Version 5.0 Page 25 - 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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