Inspection on 08/06/05 for 5 Priory Drive

This inspection was carried out on 8th June 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 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 Priory Drive 01/03/07

5 Priory Drive 13/12/05

5 Priory Drive 09/12/04

5 Priory Drive 20/07/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Priory Drive 5 Priory Drive Totnes Devon TQ9 5HU Lead Inspector Graham Thomas Announced 8 June 2005 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. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service 5 Priory Drive Address 5 Priory Drive, Totnes, Devon, TQ9 5HU 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) 01803 867554 enquiries@thepriory.org.uk Katherine H L FinniganThe Very Rev Archpriest Benedict Ramsden, Mr Simeon Ramsden, Mrs Lilah Ramsden Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9 December 2004 Brief Description of the Service: 5 Priory Drive is a small residential home, set close to the centre of Totnes, providing care for up to three service users with a mental health problem. The home is one of a number operated by the Community of St Anthony and St Elias, a partnership providing care in small domestic settings in the Totnes or Plymouth areas. For ease of reference The Community of St. Anthony and St. Elias will be referred to as “the Community” throughout this report.The home is a domestic property, adjacent to two other properties owned by the Community. Three bedrooms are provided for service users, with bathroom and toilet facilities, a kitchen, a conservatory/dining room and a small lounge. There is an attractive small garden and limited parking. Service users have access to the services of the Community such as an extensive outdoor activities programme. At the time of inspection, a new manager had recently been appointed and was awaiting registration. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection, the Inspector examined a pre-inspection questionnaire provided by the Manager. At the home, the Inspector spoke with four staff, the two service users, the Manager and a visiting Clinical Psychologist. Both the Care plans were examined as well as other documents. The Inspector also had a telephone conversation with the Community’s finance Officer and spoke with the Health and Safety Officer. What the service does well: What has improved since the last inspection? What they could do better: Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 6 There must be better information in the home about the Community and the home. Storing and recording medicines must be made safer. There must be a plan to show how staff training will meet national targets. The manager should show that she has regularly checked service users’ diets. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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 Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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) 1, 2, 4, 5 Information held on-site about the home and its purpose is not adequate for visitors and service users. Prospective service users are given enough information to make an informed choice about living in the home. EVIDENCE: The home has brochures which provide the basis, with inserts of a Statement of Purpose an Service Users’ Guide. However, in both cases, the inserts were missing from copies held in the home. The file of a recently admitted service user contained pre-admission assessments made by Community staff and the referring authority. A care plan had been produced which was signed by the service user. A Clinical Psychologist from the referring authority had provided assistance with the assessment and was maintaining contact with the service user during the transition process. The file showed the involvement of other mental health professionals. The service user confirmed that she had been visited by the Community’s staff prior to her placement and had received “very useful” information about the home and the Community. Visits and overnight stays at the home were also confirmed. At the time of inspection, the service user was undertaking a threemonth trial placement which was detailed in her contract, a copy of which was placed on her file. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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 and 9 Service users are well supported to make choices and decisions about their lives. EVIDENCE: Both service users’ plans were examined and discussed with the service users, staff and the Manager. Both plans had been recently reviewed and signed by the service users. Each set out individual goals as well as describing restrictions on freedoms and choices which had been agreed. There were agreed procedures for any episodes of challenging behaviour. Documents relating to the Care Programme Approach were seen on the files. Staff described ways in which service users were supported to make decisions about their lives in both everyday and larger matters. Service users confirmed support for their choices and preferences in domestic routines, diet and matters concerning visitors and families. Restrictions on choices were welldocumented in the plans and understood by service users. The Community’s Finance Officer acts as appointee for one service user. Though not examined on this occasion, systems for auditing this process have been inspected. Risk assessments were seen on individual files. The Community has clear strategies, including on-call advice and support, to manage and minimise risk. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 10 Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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 standard(s) 12, 13, 14, 15, 16, and 17 Service users are well supported to maximise their choices about the way they live. EVIDENCE: Neither of the current service users is presently in open employment. However, the Community provides a range of opportunities for service users which include voluntary work and support to attend adult education. Service users, staff and individual records confirmed their regular visits to shops cafes and other local amenities. On the day of inspection, one service user left for a shopping trip by public transport to a neighbouring town. The home also uses the Community’s pooled transport to support various trips. The staff shift system enables support for service users activities throughout the day and evening. The Community has its own outdoor activities programme to which all service users have access. One service user spoke about activities including canoeing and swimming. Individual interests in music, for example, were reflected in the contents of their rooms. Discussion with the Manager, examination of care plans and the Community’s activity programme confirmed that opportunities Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 12 are offered to service users to extend the range of their activities and interests. Service users’ holidays are supported by the Community. Both service users expressed satisfaction at the level of support given to maintain contact with their families and friends. This included a trip to the midlands to visit family, and help with letters, cards etc. Observation during the inspection demonstrated a high level of supportive interaction between staff and service users. One service user chose to eat alone at lunchtime and this choice was respected. Each service user’s room has a lock and service users have keys to their rooms. Permission was sought by staff before entering service users’ rooms. Housekeeping tasks including preparing meals, shopping and cleaning are shared between staff and service users. Rules on smoking, alcohol and drugs are made explicit and these are understood by service users. The inspector joined a mid-day meal with service users, staff and a visitor. The meal was relaxed and congenial and taken in the dining area which is in the home’s conservatory. The food was fresh, nutritious and attractively presented. Each service user has the opportunity to choose his/her preferred meals. Shopping for food on a daily basis forms part of the home’s routine and enables service users to plan and participate in meal preparation. Service users and their records confirmed that individual needs are catered for. During the inspection, one service user was being supported and encouraged to make healthy dietary choices. Meal plans are kept and there is space on these forms for review by the Manager. Whilst it was clear that a healthy and balanced diet is provided, it is recommended that the Manager should sign the forms to provide evidence that the menus have been regularly reviewed. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users benefit from well organised healthcare support. Current practices concerning the recording of the administration of medicines place service users at risk. EVIDENCE: Individual plans clearly identified individual needs for personal support. Service users confirmed that the home’s routines were flexible and allowed for choices about bed times, baths and other activities. Detailed records concerning the involvement of mental health professionals, family and friends were seen on individual files. Records and discussion with service users and staff confirmed service users’ access to both specialist and routine healthcare. This included, for example, recent surgery and physiotherapy for one service user and dental treatment for another. Individual health care needs are identified in the care plans and this was reflected in discussions taking place during the inspection about diet and exercise with one service user. Systems for the receipt, storage, handling and recording of medicines were examined. No Service users currently self medicate. Secure storage is provided for medicines. However, as controlled drugs were in use, this should be securely fixed to the wall. A monitored dosage system is in use. Medicines administration records were generally up-to date and in good order. However, Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 14 there was no separate record of controlled drugs. Where loose tablets were being dispensed from the separate containers it was not clear from the recording system how many remained in the container. Patient information leaflets were available on file. Records of annual Pharmaceutical inspections were seen. Training in medicines is provided in house by the Community. This includes observed practice and the Community’s policies. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Service users are enabled to feel confident that their concerns will be heard and that they will be kept safe. EVIDENCE: Discussion with service users showed them to be well aware of the home’s complaints procedures. Each expressed satisfaction that their concerns would be listened to and could identify channels for airing those concerned, including the Commission. A recent adult protection issue of which the Commission had been notified had been well managed and concluded to the satisfaction of the service user concerned. This had been fully and comprehensively recorded. Staff displayed a detailed and creditable knowledge of adult protection procedures in which they had received training as part of their induction programme. Individual risk assessment and management plans showed approaches to be taken concerning challenging behaviour. Discussion with staff demonstrated their understanding of non-physical interventions. Training is provided in de-escalation and control and restraint techniques. Since the last inspection, banking arrangements for service users monies had been separated from the Community’s own accounts. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, and 30 Service users enjoy a clean, comfortable, homely, safe and accessible environment. EVIDENCE: A tour of the premises was conducted by the inspector. On inspection, they were found to be generally clean, comfortable, homely and accessible. All local amenities available in the centre of Totnes are within short walking distance. There is a well kept and attractive garden at the rear of the premises which service users were enjoying on the day of inspection. The ground floor includes a comfortable, domestically furnished, communal lounge and a dining area sited in a conservatory with views to the garden. There is recently refurbished and well equipped kitchen and a separate laundry. The laundry has impermeable floors and cleanable walls. The washing facilities meet the current requirements of the National Minimum standards. One service user’s room, currently unoccupied is on the ground floor. Opposite this room is a separate toilet. An office, bathroom, staff sleep-in room and two service users’ rooms are situated on the first floor. One service user’s room contains an en-suite shower. There was some evident mould growth in the shower and this should be cleaned and re-sealed if necessary. All areas are well decorated and Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 17 adequately ventilated and lit. The newest service user confirmed that she had chosen the décor in her room. All service users’ rooms are lockable and have lockable storage within the room. Individual rooms reflected the personal tastes and needs of their occupants and contained many personal items. Maintenance requests had been submitted for minor issues identified during the inspection. Records of safety checks for gas, electricity and fire equipment were available for inspection. Grab rails had been fitted to the toilet and bathroom to assist service users. Staff have adequate accommodation including storage facilities. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 18 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) 32, 34 and 35 Service users are supported by staff who are clear about their roles and responsibilities. However, the likely failure to meet national training targets will adversely affect the service provided to service users. EVIDENCE: Observations of staff showed them to be relaxed, approachable and skilled in communicating with service users. Discussion with staff and records examined confirmed the contents of an intensive two week induction programme before commencing duties. This includes health and safety subjects as well as an introduction to mental health issues and adult protection. There is further induction to individual homes. Training plans are managed centrally by the Community. Individual training needs are identified through supervision and staff confirmed attendance at refresher courses for fire awareness and first aid. Under current staffing arrangement, the home will not meet the requirement to train 50 of staff to NVQ level 2 or above by the end of 2005. Staff files contained evidence of CRB / POVA checks and two references. The recruitment procedure includes time spent with service users from whom feedback is sought. Staff receive statements of terms and conditions and GSCC codes of practice. New staff members serve a minimum three month probationary period. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 19 Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 20 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, 39 and 42 Service users cannot be confident that their views underpin the development of the home. The health, safety and welfare of service users and staff is generally well-promoted and protected. EVIDENCE: Since the last inspection, a new manager has been appointed who holds NVQ level 4 / Registered Managers Award. She has clear areas of responsibility and has already made improvements to the quality and organisation of some of the recording and communications systems in the home. She is presently awaiting the outcome of her registration application. A quality assurance system has been agreed for the whole community which was discussed with the Community’s Health and Safety Officer who is responsible for its development. This includes Registered Providers’ visits, one of which had been recently undertaken. The application of the policy is not yet evident in the home in terms of service user involvement or a clear annual development plan. Staff confirmed that they receive training in health and safety topics during induction. Anticipated refresher training is also recorded and was confirmed by Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 21 staff. Hazardous substances are kept in a locked room and data sheets are available in the home. Up-to-date records of gas, electrical and fire checks and maintenance were seen by the inspector. A maintenance log was also seen. Action is taken to rectify hazards. For example, the home’s fridge/freezer was being replaced at the time of inspection as it was failing to maintain the correct storage temperatures. Risk assessments for environmental hazards have been conducted as well as for individuals. A record is maintained of all accidents. Safety procedures were posted in the home and policies and procedures were available for inspection. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 Priory Drive Score 3 3 Standard No 24 25 26 27 28 29 Score 3 x 3 3 3 x Version 1.20 Page 22 D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc 8 9 10 LIFESTYLES x 3 x Score 30 STAFFING 3 Standard No 11 12 13 14 15 16 17 x 3 3 4 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 23 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. 1. Standard 1 Regulation 4, 5 Requirement The Manager must produce a complete Statement of Purpose and Service Users Guide and make these available in the home A separate record of contolled drugs must be instigated in accordance with the guidance of the Royal Pharmaceutical Society The storage for controlled drugs must be frimly fixed to the wall Records must clearly show the remaining numbers of tablets where they are not administered through the monitored dosage system The Registered Provider must provide the Commission with a plan detailing how national training targets for staff will be met. Timescale for action 8.7.05 2. 20 13 8.7.05 3. 4. 20 20 13 13 8.7.05 8.7.05 5. 32 18 8.9.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 24 Priory Drive 1. 17 The Manager should sign menu plans to provide evidence that the diet has been monitored and reviewed. Priory Drive D54-D07 S3633 5 Priory Drive V221391 080605 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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