Inspection on 27/08/08 for 5 Mierscourt Close

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

5 Mierscourt Close 04/10/06

5 Mierscourt Close 22/02/06

5 Mierscourt Close 22/09/05

5 Mierscourt Close 10/03/05

5 Mierscourt Close 05/01/05

5 Mierscourt Close 30/03/04

5 Mierscourt Close 06/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 5 Mierscourt Close Rainham Kent ME8 8JD Lead Inspector Elizabeth Baker Unannounced Inspection 27th August 2008 09:30 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 5 Mierscourt Close Address Rainham Kent ME8 8JD 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) 01634 372048 Mr Daniel Stanley Hobday Mrs Marian Audrey Hobday Care Home 1 Category(ies) of Learning disability (1) registration, with number of places 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Learning Disability Date of last inspection 4th October 2006 Brief Description of the Service: 5 Mierscourt Close is a small care home which provides care for one adult with a learning disability who resides there as part of the family. The home is situated in a quiet cul-de-sac in Rainham. It is situated close to the High Street and local amenities. Bus and train links are close by enabling easy access to other areas. The accommodation is a dormer bungalow with the resident’s bedroom and main living areas on the ground floor. Current fees are £2,367.20 per four weeks. The resident receives a weekly allowance and is responsible for paying for some personal items such as clothes as well as activities and holidays. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the person who uses the service experiences excellent quality outcomes. Link inspector Elizabeth Baker carried out the key unannounced visit to the service on 27 August 2008. We (the Commission) contacted the owners the afternoon prior to the visit. This was so arrangements could be made for the one resident living at the home to be present for the inspection visit. The visit lasted three hours. As well as briefly touring the home, the visit consisted of talking with the resident and owners. The home does not employ any staff. Verbal feedback was provided to the owners during and at the end of the visit. At the time of compiling the report, in support of the visit, we received survey forms about the service from a relative, care manager and two advocates. At our request the home completed and returned to us an Annual Quality Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. We have not received any complaints about the service. The AQAA records there have been no safeguarding referrals. No referrals have been made to the Vulnerable Adults List either. What the service does well: The owners are receptive to advice and suggestions made, and demonstrated a desire to quickly rectify matters, which required attention and or change in practice. The home provides an excellent environment for the resident to live in. The resident is supported in maintaining links with his family as well as being treated as part of the owners’ family. The owners go to great lengths to ensure the resident receives the appropriate level of support from other agencies involved in his care. This includes “demanding” the local authority carries out care reviews particularly when they are overdue. Survey responses included “The home provides accurate information, client has a varied social life within a caring and structured home. The providers always appear to be open and engage with all services involved in the resident’s care”. “They are doing a very good job under great distressing circumstances and conditions. If there is any problem I always hear from them as soon as possible. They look after [relative] very well and he is happy there”. And “[the owners] allow independence and integration into the community, encourage friendly trips and relationships, allow freedom and rights of choice and resident maintains regular contact with his family”. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. The resident who uses the service experiences good outcomes. This judgement has been made using a range of evidence including a visit to this service. The home meets the resident’s needs. EVIDENCE: The resident has lived with the owners since 1995. The resident indicated during the visit that he likes living at the home. The home’s statement of purpose and service user guide have been individualised to reflect his specific circumstances. The home is only registered for one resident. And when the resident no longer lives at the home the service will cease. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The resident who uses the service experiences excellent outcomes. This judgement has been made using a range of evidence including a visit to this service. The resident can be sure his needs and aspirations will be met. EVIDENCE: The resident’s care records included care plans, risk assessments and seizure charts. A diary is maintained on a daily basis which provides good information on the resident’s quality of day experiences. Medway Council also provide a care plan. The council should review the resident’s care every six months. However because of administrative delays being experienced by the council, the care review timescale had expired. The care review was finally carried out in June 2008, following the owners repeated requests and an actual site visit to the council’s offices. The resident takes part in his care reviews, as is good practice. Risk assessments are reviewed annually and cover different areas of the home and grounds. For the resident’s safety action is taken to minimise potential 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 10 risks, this includes installing containers in the garden for the safe disposal of cigarette ends. A review of a care record contained information of an injury sustained by the resident whilst taking a shower. Although there is a showering risk assessment, the assessment had not been updated to reflect the new problem. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. The resident who uses the service experiences excellent outcomes. This judgement has been made using a range of evidence including a visit to this service. Community links support and enrich the resident’s quality of life. EVIDENCE: The resident is not in employment or education but for occupational purposes attends a day centre five days a week. The resident participates in various activities at the day centre including arts and crafts, swimming, horse-riding and using a gym. The resident is very sociable and enjoys meeting people. Although the resident does not go out unescorted, he is visits venues and amenities, such as local pubs, folk festivals, shops, costal and town centres with the owners and their family members. The resident treats the care home as his own home. He is able to relax in the lounge or conservatory and rear garden as he wishes. Although the resident does not cook any of his meals, he makes cups of tea and likes to assist the 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 12 owner in baking. The home’s routines are flexible and the daily diary entries record the resident getting up and going to bed when he wishes. Following a healthy eating plan the resident has lost a bit of weight. Indeed one of his relatives remarked that he looked very well “especially now he has lost a bit of weight”. The resident described his typical breakfast which included choices of cereals, toast and porridge depending on the season and as always a cup of tea, which he thoroughly enjoys. Menus offer variety and choice. As well as taking holidays with the owners, the resident is supported in keeping in contact with his relatives out of the county. This includes trips to Sussex. And the resident’s father is due to stay with him at the home shortly. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. The resident who uses the service experiences excellent outcomes. This judgement has been made using a range of evidence including a visit to this service. Personal care support promotes the resident’s self-esteem. EVIDENCE: The resident is supported in attending appointments and consultations with health care professionals as per his assessed needs. This includes the GP, optician and dentist. The resident is also supported in maintaining his personal care needs. Indeed the resident looked very smart. His appearance is obviously very important to him. The resident is unable to self-medicate so the owners administer his medications. The resident’s medicines are reviewed annually by his GP, as is good practice. The owners maintain medication administration (MAR) charts as evidence of medicines administered. The charts inspected indicated that two of the six prescribed medicines were not being administered. One was a regular dose medicine and the other was administer when prescribed (PRN) medicine. However there was no record why the regular dose medicine was not being administered or precise administration details of the PRN medicine in the resident’s corresponding care records. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 14 It was identified on this visit that for convenience purposes the owners dispense the resident’s medicines from the original packaging into other containers and then into a dosette box. This is triple dispensing and for the resident’s safety is considered unacceptable. Whilst acknowledging only one resident lives at the home, Regulation 13(2) requires providers make arrangements for the recording, handling, safe keeping and safe administration and disposal of medicines received into the care. Because of this the owners will now be contacting the dispensing pharmacies for professional advice on how the situation can be made safe. To assist owners in the safe practice of medicine administration and management we have issued Professional Advice. The guidance is available on our website www.csci.org.uk. The owners obtained a copy of our Professional Advice: The administration of medicines in care homes during this visit. The resident will probably live at the home for the rest of his life. Care records contained burial details. However there was no indication of his spiritual or cultural preferences and or wishes in the event of death and dying. Whilst recognising the sensitivities of getting this information, this is an important aspect of care and should be addressed. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The resident who uses the service experiences good outcomes. This judgement has been made using a range of evidence including a visit to this service. The resident is protected from abuse and his views are listened to. EVIDENCE: The returned AQAA document indicates the home has not received any complaints about the service. We have not received any complaints about the service. The AQAA also indicates the home has safeguarding adults and the prevention of abuse policies and procedures. Visitors, friends, care manager and health professionals are able to note their comments in the home’s compliments book. It was identified on this visit that the home’s complaints procedure does not include our address or telephone number as required by Regulation 22(7). For ease of reference this information must be added. The resident’s financial affairs are managed by Medway Council. However the home assists the resident in managing his weekly personal monies. The owners go out of their way to obtain receipts for services provided or items purchased and or obtained on the resident’s behalf. This is good practice. The owners maintain detailed financial schedules of all the transactions for auditing purposes. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The resident who uses the service experiences excellent outcomes. This judgement has been made using a range of evidence including a visit to this service. The standard of the environment is excellent providing the resident with an attractive, comfortable, clean and homely environment to live in. EVIDENCE: The home is an extended semi-detached bungalow, situated near to Rainham High Street. It is typical of the surrounding area and there is nothing to determine this is anything other than a family home. The premises are kept in an excellent condition throughout. The resident has his own bedroom on the ground floor, which is suitably equipped and individualised to reflect his personality. The resident shares the communal rooms, including the shower room, lounge and conservatory with the owners and has his own things in these rooms as would any family member. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. The resident who uses the service experiences good outcomes. This judgement has been made using a range of evidence including a visit to this service. The owners know and support the needs and preferences of the resident. EVIDENCE: The home does not employ any staff. The owners provide all the care and support to the resident. They have done this since 1995. Standard 34 is not applicable to this home. The resident indicated he likes living at the home with the owners. The owners endeavour to keep up to date with current good practice and regulation. Training recently accessed includes health and safety (fire, manual handling, first aid, accident and incident reporting), basic food hygiene, understanding of the Mental Capacity Act and Care and Administration of Medicines. We are informed that the home will cease to operate as a care home when the resident no longer lives at the home. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The resident who uses the service experiences good outcomes. This judgement has been made using a range of evidence including a visit to this service. The resident lives in a well run home. EVIDENCE: The owners have run the home since it was first registered. Indeed the home was specifically registered to accommodate the one resident. The owners have previous experience in social care. The resident said he likes living at the home with the owners. Good interaction was seen between the resident and owners during the visit. The resident is not able to give his views on the home in a structured way. However the owners ensure good contact is maintained with the resident’s family, friends and day centre and actively encourages feedback on his behalf. A review of the compliments book at this visit included comments such as “Lovely, clean, 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 19 warm and welcoming home”, “Resident well and happy to interact with the meeting”, “Resident came and visited us and we found him looking very well. He has been well cared for”. And “He looks well looked after”. The AQAA records that the home’s policies and procedures are annually reviewed. The AQAA also records that the home’s equipment is serviced or tested as required by the manufacturer, as applicable to this home. The resident described the action he takes when the home has a fire drill. However it was identified on this visit that the home does not record these drills. It was further identified that home has not yet completed a fire risk assessment, which all businesses, including care homes, are required to complete, under the Regulatory Reform (Fire Safety) Order 2005. It is the owners’ responsibility to ensure that home is safe. We required the owners to seek the Fire Safety Authority’s specialist advice. Accident and incident records are maintained and photographic evidence is also obtained where there is a need. This is good practice. 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 3 3 X 3 X X 2 X 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 21 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 5 Mierscourt Close DS0000028861.V370751.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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