Inspection on 11/07/05 for 44 Dexter Close

This inspection was carried out on 11th 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

44 Dexter Close 09/03/09

44 Dexter Close 13/03/07

44 Dexter Close 20/02/06

44 Dexter Close 22/11/04

44 Dexter Close 06/04/04

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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 Dexter Close (44) 44 Dexter Close Grays Essex RM17 5AU Lead Inspector Vicky Dutton Unannounced 11 July 2005 13:00 th 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. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Dexter Close (44) Address 44 Dexter Close Grays Essex RM17 5AU 01375 296497 01708 851133 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) South Essex Special Needs Housing Association Ltd Mrs Joan Day CRH Care Home 2 Category(ies) of LD Learning Disability registration, with number of places Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22nd November 2004 Brief Description of the Service: 44 Dexter Close provides care and accommodation for up to two adults with a learning disability. The home is owned and managed by South Essex Special Needs Housing Association (SESNHA). The home is a three bed roomed house situated in a quiet cul-de-sac in Grays. It has a small enclosed rear garden. The shops in Grays are 10 minutes walk away. Local amenities are available. The home offers 24 hour care and aims to achieve a small family like environment. Family involvement is encouraged. Residents are assisted to plan holidays and are transported to a variety of community activities. The home has their own transport in the form of a people carrier vehicle available. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 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 a period of two and a half hours. The inspection considered a number of the National Minimum Standards. The registered manager was not available but the inspector was ably assisted by the deputy manager, who was present throughout the inspection. A tour of the premises took place and care and staff records were inspected. Two residents were being accommodated and at home during most of the inspection. One resident was spoken with. The other resident has more complex communication needs. No visitors or visiting professionals were present during the inspection visit. What the service does well: What has improved since the last inspection? What they could do better: The home need to make sure that residents are kept safe by assessing all areas of risk, and ensuring that staff are aware of what to do to minimise the risk. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 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. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 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 Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 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, 3, 4. A recent admission to Dexter Close had their needs assessed before moving into the home. The move was planned and executed so as to provide the least distress to the resident. EVIDENCE: The care files of a recent admission were viewed. Staff from Dexter Close had visited the resident in their previous placement to carry out an assessment. Due to the residents complex needs visits to Dexter Close before the move were not possible. However careful planning was undertaken and a ‘care plan for relocation’ was established and worked to. Staff at Dexter Close have the communication and other skills to meet residents needs. One resident has shown real progress since moving into the home. Staff would however benefit from specific training in managing challenging behaviour. This has now been planned for some time but not yet taken place. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 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, 7, 9 Residents care plans reflect their needs and show that they are encouraged to make choices and decisions in their daily lives. EVIDENCE: The care plan of a recently admitted resident was viewed. This was detailed and gave specific instructions to staff as to how to meet the residents needs and maintain their preferred routines. A new member of staff said that they had found the format easy to follow and helpful, as the resident has complex needs and is largely unable to verbalise his wishes. During the visit staff were noted to encourage residents to make personal choices and decisions. Risk assessments are in place for some relevant areas. A risk assessment could not be found in respect of one residents preferred activity of looking out of their bedroom window. As this could pose a potential hazard a risk assessment should be undertaken. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 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, 14, 15, 16, 17. Residents are encouraged to undertake activities that will aid their personal development. Family contact is encouraged and maintained. Residents are able to choose what and when they wish to eat. EVIDENCE: Neither resident at Dexter Close attends any formal day care placements. This is through choice in one case, and complex needs and unwillingness to leave the building in another. One resident enjoyed telling the inspector about a voluntary job that they hoped to soon start. From discussions with staff it was clear that residents are offered options to undertake developmental courses and other activities. One resident will not currently leave the premises. The other service user enjoys their personal choice of activities. Trips are arranged on an individual basis or, as in the case of a recent holiday to Norfolk, in conjunction with the residents of the jointly managed sister home to Dexter Close. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 11 Family contact is maintained as far as possible and appropriate. One resident currently visits home most weekends. Staff interaction with residents is constant and positive. During the inspection it was clear that each resident is free to choose when to be alone, and are free to go where they wish in the building. One resident smokes and is aware of where in the building this is allowed. Dexter Close allows residents to choose what they wish to eat. Conversations with staff showed that personal preferences in terms of times of meals are respected. On the day of inspection one resident was going shopping with a member of staff to select and buy food. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 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 standard(s) 19, 20 Residents healthcare needs are assessed and met. Medication at the home is managed safely to protect residents. EVIDENCE: Care files and discussion with staff showed that residents have their healthcare needs met. Professional input from, for example, behaviour therapists and speech therapists is sought when required. Residents are assisted to attend scheduled hospital appointments and routine checks. One resident will not currently leave the premises. Advice needs to therefore be sought from the local PCT regarding a suitable domiciliary dentist. The medication records and system, (monitored dosage), were viewed and no anomalies were noted. The system is regularly audited by the providing pharmacist. The home has three new members of staff. The deputy manager said that although formal training is not available until September, all staff have had a comprehensive in house induction. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 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 standard(s) 22, 23 The home has a complaints process in place, and residents are encouraged to express any concerns. Staff are aware of adult protection issues. EVIDENCE: No complaints have been received by the home or CSCI. A resident spoken with said that they knew how to raise any concerns with the staff or management of the home and was sure that things would be dealt with properly. Some staff have undertaken training in adult protection. Further training for new staff will be available in August/September 2005. Records showed that adult protection is covered as part of the induction process. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 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 standard(s) 24-30 Residents live in a safe and homely environment that meets their needs. Both have their own rooms and sufficient shared communal space. EVIDENCE: Dexter Close provides a comfortable and homely environment in a community setting close to local amenities. Sufficient space is provided. There is an open plan kitchen/dining area, and a comfortable lounge. The home was well decorated and maintained. Furnishing and fittings are domestic in character. A sleeping in room is provided for staff. Both residents have their own rooms, which reflect their personal interests. A resident spoken with was happy with his room. Dexter close has one bathroom and a downstairs cloakroom. The home has a small garden, which is enjoyed by residents. Neither resident currently requires any specialist aids. The homes laundry area is situated in the homes garage, which has been organised to serve as a utility area. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 36. The homes recruitment procedures protect residents. All staff receive regular supervision. EVIDENCE: The files of three recently recruited members of staff were viewed. All showed that appropriate recruitment practices are followed and that residents are looked after by staff who are suitable to do so. One resident contributes to the recruitment process. Staff records showed that staff receive regular supervision to support them in their role. New staff are enrolling to undertake NVQ level two. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 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 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) 37, 38. Residents benefit from a well run home that is focused on their needs and views. EVIDENCE: The registered manager and deputy manager are both experienced and hold NVQ level four/Registered managers awards. Dexter Close is a small home providing care to a maximum of two service users. The registered manager, staff, residents and one residents family all appear to communicate and interact closely in an open and friendly environment. Although one resident has complex needs, staff constantly encourage them to express their views by signs or other means. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 17 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 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Dexter Close (44) Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 18 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 39 Regulation 24 Requirement The results of any quality reviews to be sent to the Commission For Social Care Inspection. Previous requirement date of 01/06/05. This standard was not assessed at this inspection. This requirement is therefore carried forward. Timescale for action 01/09/05 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 3 9 19 Good Practice Recommendations To enhance residents care staff should be trained in all relevant areas including managing challanging behaviour. Risk assessment should be in place to cover all relevant areas. Advice should be sought from the local Health Authority as as to how to meet the dental needs of one resident. Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 19 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 Dexter Close (44) I56 I06 S18061 Dexter Close V238395 110705 Stage 4.doc Version 1.40 Page 20 - 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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