CARE HOME ADULTS 18-65
57 Clarendon Villas Basement Flats Hove East Sussex BN3 3RE Lead Inspector
Jenny Blackwell Unannounced Inspection 26th November 2005 10:00 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 57 Clarendon Villas Address Basement Flats Hove East Sussex BN3 3RE 01273 774014 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) clarendonvillas@onetel.com Southdown Housing Association Limited Mr Anthony Lyons Care Home 2 Category(ies) of Learning disability (2) registration, with number of places 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The number of people accommodated must not exceed 2 The people accommodated will be between the ages of 18 and 65 years Date of last inspection 28th May 2005 Brief Description of the Service: 57 Clarendon Villas is a detached house in a residential road in Hove, close to local shops. Buses pass near to the home, and the shops and train station are within easy walking distance. The accommodation for the people who live there is on the ground floor, this comprises of two individual flats. Each has a kitchen, bathroom, bedroom, and sitting room overlooking the front of the house. Each flat has access to the staff sleep-in room. The service is one of several homes in the area run for people with learning disabilities by Southdown Housing Association.There is a small amount of front garden, and, to the rear of the property, the area is concreted. The patio is used in good weather for barbeques. There is a wooden, garden swing seat, herb garden and shed available to the people who live there. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During this summary and report the people who live at the home will be referred to as people/person (except in the requirements section), and the people who work at the home as staff or by their job title. The two people who live at the service, some of the staff team and the manager were present during the inspection. Time was spent with one of the people living at the home. The other person was unwell and was resting in bed. The manager was spoken to individually and two staff was spoken to throughout the day. The four requirements made from the inspection in May 2005 were checked to see if they had been met. The manager produced evidence to show that three of the requirements had been met. One requirement will be carried forward. The inspection was unannounced and most of the time was spent on a trip out with one of the people and the manager. The people who live at the service and the staff were helpful throughout the inspection and contributed to the report where possible. What the service does well:
The 1:1 support was observed during the trip out and the manager demonstrated indepth knowledge of the person. The service focuses on participating in the community and both people were expected to do as much for themselves as possible. One person has clear preferences about who supports him in his activities. The manager ensures the rota is written to accommodate the people’s wishes. The knowledge of the support needs of the individuals and the running of the home was shared amongst the team. The staff worked on their own with the people and were solely accountable for the shifts. The staff spoken to were able to talk about the running of the shifts, their responsibilities with shift planning and what to do in an emergency in the absence of the manager. The support plans were viewed during the inspection. They contained detailed information about the support needs of each person. The plans focused on the abilities of the people as well as their disabilities. The service is set up to support the rights of the individual. The organisation is currently looking at issues of consent and people’s rights particularly around medical interventions.
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 6 Southdown Housing Association has a comprehensive induction and training programme for new and existing staff. A new member of staff was spoken to and confirmed that he had been suitably inducted into the service and had access to training. 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.
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 the following standard(s): 2 and 5 Not all of the people had their placements and aspirations assessed. The current group of people were having their needs met by the home. Each person has a Licence Agreement with the organisation, that contains the terms and conditions of living at the home. EVIDENCE: Brighton and Hove City Council had not reviewed one person’s placement annually. The manager and organisation ensure that it reviews each person support needs and goals regularly, including the person in the process. This happens according to the organisation’s policy and the staff demonstrated a commitment to this process. However the placing authorities had not conducted the annual review of some of the people’s community care assessments. A discussion took place between the manager and inspector about the expectation in the National Minimum Standards for the manager to ensure these assessment reviews take place. Although the manager could not guarantee the social workers from the placing authorities would conduct the reviews, he must provide evidence that he has requested the reviews take place annually. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 9 The two people have lived at the home for some years and there are no plans for them to move out and have a new person move in. The home had an admission policy. It includes providing prospective people to visit the home, to have compatibility studies and provides people with a licence agreement. The agreement details the terms and conditions of residency and efforts have been made to simplify the document and put it into pictorial format. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The people have their changing needs and goals written in their support plans and reviewed regularly. Both people are at the centre of the decision-making in their lives. Risk assessments were in place that enabled the people to live independent lives as much as possible. EVIDENCE: The support plans were viewed during the inspection. They contained detailed information about the support needs of each person. The plans focused on the abilities of the people, as well as their disabilities. Since the previous inspection some language that described the support of the person’s behaviours had been changed. This was now more positive and clearer for staff to follow. The support plans described in detail the way that staff should approach each persons. This helps the people to receive a consistent approach by staff. Throughout the plans emphasis was put on consistency and continuity of approach. The manager reported that one person’s behaviour had greatly
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 11 improved since the staff had begun to build the service around him, instead of trying to fit him into a service. The plans contained detailed risk assessments based on supporting people to be involved in their daily lives. For example, participating in household tasks and participating in their local community. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. The manager and staff were committed to supporting each person with their interests. Each person was actively engaged in their local community and had good links with family and friends. The people’s rights were respected and people were encouraged to take responsibilities in their lives. The meals appeared generally nutritionally balanced. EVIDENCE: One person attends a day service, and both attended college courses and leisure activities. One person had all his day opportunities arranged by the home. One the day of the inspection one person was not well and was resting in bed. The other person was due to go out to do some shopping and then on to a “drive through” restaurant. The inspector went with the person and the manager out on the trip. The person was asked where he wanted to go and the manager used a combination of signing, language and photos to ascertain the person’s choices.
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 13 This continued throughout the trip to the supermarket and restaurant. At the supermarket the person was encouraged to fully participate in the shopping and was asked at each stage about his preference when choosing items. The manager described that certain items were bought during the shopping to help the person understand that the shopping was coming to an end. It was clear during the trip out that the manager had detailed knowledge of the person and his preferences. The person was relaxed and appeared to be confident with the manager’s support. Both the people used local supermarkets shops and cafés on a regular basis. The staff team are very active in engaging the people with their local community. One person attends an organised day centre during the week. From there he also engages in community activities such as recycling materials. Family involvement is encouraged and supported by the staff. The manager was aware of the issues of supporting people with their wellbeing and ensuring the person’s rights were protected. The meals for each person are prepared in their flats, mainly by staff, although the people are encouraged to participate as much as possible. The manager stated the staff were continuing to monitor the amount of takeaway meals that one person had during the week. The staff were aware of the need to help the people have a healthy diet. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18-21 The personal support was delivered in the way the people preferred. Both people who live at the service were supported to maintain their wellbeing. They attend community health care appointments and have access to specialist health care provision. The medication procedures were clear and have improved. The manager and staff had specialist knowledge of the ageing process and had identified the wishes of the people or their relatives in the event of their death. EVIDENCE: The ways in which the people preferred to receive personal care support was recorded in their support plans. All the staff team was expected to follow the morning and evening routines, which were written in detail. The staff ensure that the people attend regular check ups with dentist and doctors. The manager demonstrated a good understanding of supporting people with check ups when they were anxious about attending appointments. He described particular routines that the staff follow when supporting a person to go to the dentist. A check was carried out of the medication system. The manager had introduced better recording systems for the administration of medication. The staff team are using this system to monitor stock of medication.
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 15 The manager had identified the wishes of the family in the event of illness or death of the people who live at the home. The manager was able to describe the details of the arrangements for one person that adheres to his faith. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The organisation operates within procedures to protect people from abuse. The manager and staff worked in line with the procedures and demonstrated knowledge of their roles and responsibilities in protecting people and reporting suspected abuse. EVIDENCE: Since the previous inspection the manager and organisation have ensured that all staff have received adult protection training. The staff team attended an inhouse training session ran by the manager, a list of attendees was seen. The course covered definitions of abuse, a reporting flowchart and information about the Protection of Vulnerable Adults scheme. The manager had attended a training day, run by the organisation, that looked at particular issues in the service such as working on a 1:1 basis with the people. He was also booked on a course run by Brighton and Hove City Council about adult protection. On the return to the service the manager was observed reconciling the person’s money. The procedure of recording and monitoring the use of the person’s money was checked. Appropriate procedures were in place and all staff used the same recording system for each person. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Each person’s flat was adapted to meet their needs. Full access to one person’s flat was not possible. EVIDENCE: On the day of the inspection one of the two people was not very well and was resting in bed. A visit to his flat was not possible although the manager stated there had been not been any changes to the accommodation. Most of the time during the inspection was spent on a trip out with the other person and the manager and only a brief visits was made to his flat. At the previous inspection it was required that a radiator guard was fixed to a radiator in one persons bathroom. This had been installed and now protected the person from the hot radiator. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 The current staff team were competent and qualified in supporting people with learning disabilities. The home and organisation had robust recruitment procedures that support and protect the people. The organisation invests in the induction and training of its staff and the manager monitors each staff member through supervisions and staff meetings. EVIDENCE: The staff have induction and foundation training looking at supporting people with learning disabilities. A brief discussion was had with a new member of staff who had worked with people with disabilities for several years and had joined the staff team in March. The staff team had worked with the individuals for some time and attended courses on regular intervals to update their knowledge. The manager was involved with the recruitment of all the new staff to the service. Two staff were new to the service since the previous inspection and the manager confirmed that he had received all the information to ascertain the staff’s fitness to work in the service. This included a criminal records check, identification documents and references. Over 50 of the current staff team are N.V.Q level 3 qualified. All staff have access to a rolling programme of training run by the organisation, and external courses such as Adult Protection and Medication training. The staff received
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 19 induction within the first six weeks and foundation training within six months. A minimum of 8 days of training is set-aside for each staff member. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The people who live at the home benefit from a well run home and the staff team had a clear understanding of the ethos set out by the management. The manager and staff and senior managers conducted a yearly service review that needed to be compiled into a quality assurance tool. The manager demonstrated knowledge of monitoring health and safety issues. The home was generally a safe enviorment for the people who live and work in the home. EVIDENCE: The staff team support four people who live in their own flats. Two of the flats are registered with the commission and are regulated. The staff team support all four people and work between the registered services and non-registered service. The manager stated that the ethos of the service is to approach people as individuals and mainly support people on 1:1 basis. The support workers also described this when they were asked about the ethos of the service. The manager described the changes of behaviour one person was presenting now the service was organised around him. He said that the
57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 21 person’s levels of challenging behaviours had reduced, as the staff team had learnt to be lead by the individuals rather than trying to lead him. A formal process of obtaining people’s views was sought from family members or representatives annually in a service review. Feedback from people and their representatives are included in the review. Goals are set for the year and are regularly reviewed. It was recommended that the manager draw together the different aspects of the quality assurance to produce a report. The manager and staff monitor the health and safety of the home and have access to external contractors who undertake services and checks of equipment. Several health and safety documents were viewed including the homes fire plan. A “walk through” inspection checklist was seen. This was a monthly exercise that a delegated member of staff undertook in the service. Any problems that are identified in the checks are reported to the organisation or to contractors servicing equipment. Staff was trained in first aid, moving and handling and food hygiene. The accident book was seen and five accidents had been recorded. The book was being used correctly and the information was stored confidentially. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 22 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 2 X X 3 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
57 Clarendon Villas Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000014152.V249755.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES 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 YA2 Regulation Requirement Timescale for action 26/11/05 14(1)(a-c) It is required that the manager ensures the needs of the people who live at the home have been assessed by a suitable qualified person. 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 Refer to Standard YA39 Good Practice Recommendations It is recommended that the review documents are drawn together to produce a quality assurance tool. 57 Clarendon Villas DS0000014152.V249755.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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