Inspection on 14/06/07 for 56-58 Turnbull Close

This inspection was carried out on 14th June 2007.

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

56-58 Turnbull Close 10/05/06

56-58 Turnbull Close 03/11/05

56-58 Turnbull Close 24/05/05

56-58 Turnbull Close 20/12/04

56-58 Turnbull Close 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 56/58 Turnbull Close 56/58 Turnbull Close Greenhithe Kent DA9 9EB Lead Inspector Geoff Senior Key Unannounced Inspection 14th June 2007 10:15 56/58 Turnbull Close DS0000023873.V337840.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 56/58 Turnbull Close DS0000023873.V337840.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. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 56/58 Turnbull Close Address 56/58 Turnbull Close Greenhithe Kent DA9 9EB 01322 381568 01322 381852 turnbullclose@walsingham.com 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) Walsingham Mr John Henderson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2006 Brief Description of the Service: 56/58 Turnbull Close residential home (part of Walsingham which has some forty- two homes in the group across the UK) provides twenty-four hour care and accommodation for up to twelve people with physical and learning disabilities. The home supports service users who have profound learning and physical disabilities. The staff work closely with speech and language therapists and encourage families, friends and representatives to play an active role invoicing views and opinions. Mr J. Henderson is the Registered manager in day-to-day control of the home. Accommodation is in a bungalow that is divided into two units, each with its own communal areas. All residents have single bedrooms that are individually furnished and equipped with significant support from relatives and supporters. Some service users have motability vehicles. Other organisations (e.g. Yew Tree Centre and Social Education Centres) supplement the homes own transport provision in enabling residents users to attend specialist day centres. The premises have landscaped gardens used by service users. The home is within easy reach (by car) of a range of local amenities and public transport. There are good parking facilities. Weekly fees information was not available at this visit. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit undertaken between 10:15am and 16:15pm on the 14th June 2007. Time was spent talking with the deputy manager, who was the senior on duty, members of staff, a visiting relative and to a service user who was present at the time. This was with staff assistance and interpretation through their individual communication methods. Although the majority of service users were out at various activity venues for most of the day their return and interaction was observed. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the residents in the report. Some judgements are based upon direct observation of staff and service user interaction and from interaction with service users family members An accompanied tour of the premises was undertaken and a range of records viewed. The views and comments of family members and relevant professionals were also sought in telephone calls made subsequent to the visit. Not all the NMS were reviewed at this visit. Core standards subject to inspection are detailed in the text of the report What the service does well: What has improved since the last inspection? The first stages of a three year refurbishment and redecoration plan have been implemented. Additional training topics have been added to the induction process. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 6 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. 56/58 Turnbull Close DS0000023873.V337840.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 56/58 Turnbull Close DS0000023873.V337840.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 Quality in this outcome area is good. Prospective service users may visit the home and are provided with comprehensive information to help them make a decision about moving in. Assessments are undertaken to ensure that the Home can support the service user’s needs and aspirations This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current service user group is well established within the home and there have been no admissions since the last inspection visit. It was reported that prospective admissions are subject to an introduction and assessment period in order to ensure that the service user’s needs are fully assessed and can be appropriately supported by the home. Prospective service users and their families are encouraged to visit the home prior to admission and to use the opportunity to meet and spend time with the existing service users and staff, view the accommodation and find out about the routine and lifestyle they could expect to experience at Turnbull Close. The assessments, undertaken prior to, and following admission contribute to the 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 9 care planning process. Input is welcomed from the service users and families and from relevant agencies and professionals. Aspirations may be expressed and, where possible/ achievable, appropriate support is planned. The Service User Guide and Statement of Purpose were previously reported as being comprehensive. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 10 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): 6,7,9. Quality in this outcome area is adequate. Service user plans identify the needs of service users and the home ensures that healthcare needs are met. The monitoring process needs to ensure that outdated information is removed and the plans contain detail of service user led decisions affecting their daily lives. Risk assessments would benefit from clearer detail of when and who reviewed them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The content and detail provided within the service user files is intended to inform and enable new and existing staff to better understand and effectively support the needs of service users, and help them with working towards achieving goals. The level of detail, monitoring and updating in the samples 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 11 viewed was however inconsistent in that some support plans and risk assessments are for activities that are no longer undertaken. It was reported that key workers would normally support the management in this task but there are not enough permanent staff to allocate to all service users. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16,17. Quality in this outcome area is good. Service users are actively supported to access and be included in the local community and amenities. Service users opinions are sought and choices expressed. Meals are planned according to service users preferences and dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff appear to have worked positively with the service users to establish interests, likes and dislikes. They are supported by the organisation and external agencies to provide a wide range of formal and informal activities for both recreational and therapeutic purposes. At the time of the visit the majority of the service users were participating in a well-established routine of 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 13 attending the Dartford or Gravesend Day Centres. Transport is provided each weekday at 9am and 4pm. Service users were seen to arrive at 4pm, pleased to see the staff on duty and keen to tell them of their day. A communication book is in use between the Day Centres and Turnbull Close to update parties on events, progress and plans. One of the service users has a part time job. Parents and staff confirmed that service users always have plenty to do and are supported to access local amenities and community facilities. The service users also have the option of an accompanied annual holiday. Family and friends are welcomed to the home to visit service users and participate in support, activities and service reviews. Service users receive full staff support at mealtimes and have adapted cutlery and crockery for their use. They reportedly enjoy a varied and balanced diet from a menu they help to choose and that considers their preferences, dislikes and any particular dietary needs. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. The health and personal care needs of the service users are monitored and supported. Service users are assisted to take their medication in a manner that best suits their needs and ability. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are reportedly treated with respect and appropriate levels of privacy and dignity are maintained. All the service users require assistance with aspects of personal hygiene and care. The management endeavour to ensure that staff are instructed and supervised to provide support thoughtfully and sensitively. Staff spoken with indicated that they were aware of the nature of the support required for individual’s personal care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Moving and handling assessments are 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 15 regularly undertaken to ensure levels of staff and mechanical support are appropriate. The healthcare needs of the service users are monitored and addressed. The home has reportedly developed positive relationships with local GP and community healthcare teams. Additional equipment and facilities are assessed and provided according to changing levels of need. Medication records and storage facilities appeared to be adequate for the needs of the home. Records were clear and up to date. He management report that staff involved in handling medication have received appropriate levels of training. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 16 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): 22,23. Quality in this outcome area is good. Systems are in place to protect service users from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now has a complaints procedure in an easy read format. The views of the service users were not obtained at this visit. It was reported however that staff, who are more familiar with the communication methods of the individuals, are able to discern displeasure or concern and respond accordingly. The service users would need a relative or advocate formally identifying and raising concerns on their behalf. Staff and relatives indicated that they are familiar with the whistle blowing and complaints procedure and would be comfortable raising issues should the need arise. Staff have received training in protecting vulnerable people from harm. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 17 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): 24,30. Quality in this outcome area is adequate. Service users live in what presents as a generally comfortable and clean environment with a range of specialist equipment to support their individual needs. The environment will benefit from the timely completion of the planned improvements to the communal and private areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The impact on first entering the property is of tired décor and furnishings reflecting the heavy use of mobility aids. The Management was pleased to report however, that since the last inspection, the home has been authorised to undergo a considerable amount of maintenance and refurbishment works. The central heating and hot water system is almost complete as are a number 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 18 of physical improvements such as door widening and bathroom repairs. The Staff and, it was understood, some parents have endeavoured to maintain a good standard of cleanliness throughout and ensured that the service user bedrooms are decorated and furnished to reflect the wishes and character of the occupant. All service users have specialist equipment in place to meet their personal support needs in their rooms and in the bathrooms and communal areas. It is hoped that once the refurbishing works are complete, the furnishing and redecoration of the communal areas is not unduly delayed. Externally there is an enclosed garden with fishpond and seating areas and a path suitable for wheelchairs to circumnavigate the house. This is a useful space for recreation but again would benefit from upgrading and tidying away or disposal of broken tables and chairs. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 19 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): 32,33,34,35,36. Quality in this outcome area is adequate. The service users benefit from a committed and enthusiastic staff team. This would be further enhanced by recruitment to full complement. Recruitment systems endeavour to ensure service users are protected from harm. Staff are offered adequate induction and training opportunities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The management report that they endeavour to ensure that there are sufficient staff on duty at all times of the day and night. It was noted that there is a skeleton staff of two between 11am and 4pm when the majority of service users are out at Day Centres. The management must ensure that choice for anyone remaining at the house is not compromised. The core team of permanent staff contains a blend of youth and experience with a senior support worker on each shift. They are however, 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 20 insufficient in number and rely on the use of agency staff to cover the shortfall. The same agency staff are booked on a regular basis to try to maintain familiarity for residents. The recruitment process is thorough and includes checks to protect the vulnerable. It is reportedly however, somewhat protracted and a number of posts remain vacant as a result. Staff spoken with feel the organisation offers a good induction and development programme. There is a comprehensive induction process that the staff are supported to work through. Mandatory training is provided and staff receive updates and refreshers as required. Additional courses are provided to cover a wide range of issues relevant to the task. Six of the thirteen staff have attained NVQ at level 2 or above whilst another six have commenced courses. Staff confirmed that they receive regular 1-1 supervision and are able to express ideas, concerns and complaints in individual and team meetings. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 21 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): 37,39,42. Quality in this outcome area is good. An open and inclusive atmosphere has been developed in the home enabling service users and staff participation. Systems are in place to monitor and address issues relating to health, safety and welfare of service users, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 22 The management team have many years experience working with and managing services for people with a learning disability. The Manager has undertaken RMA training and the deputy has completed level 3 NVQ. An open and positive ethos in the home enables staff, relatives and service users, where possible to feedback about the service. Any issues that cannot be managed in the home are referred to external agencies for advice and guidance. The Health, welfare and safety of service users, staff and visitors are well monitored. Staff receive necessary training and induction into the service. A range of records is maintained in respect of the health and safety checks undertaken by staff on a weekly, monthly and annual basis. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 23 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 x 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 24 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 1 YA6 As a good practice recommendation that Person centre care plans continue to be developed and fully completed with up to date and accurate information. It was acknowledge this is ongoing by key workers. It is strongly recommended that recruitment to permanent DS0000023873.V337840.R01.S.doc Version 5.2 Page 25 2 YA33 56/58 Turnbull Close staffing be implemented as quickly as safe recruitment procedures will allow. 3 YA24 The refurbishment programme to be completed and redecoration undertaken without undue delay. 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI 56/58 Turnbull Close DS0000023873.V337840.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!