CARE HOME ADULTS 18-65
57 Sackville Gardens 57 Sackville Gardens Hove East Sussex BN3 4GJ Lead Inspector
Merle Blakeley Unannounced Inspection 8th December 2005 10:15 57 Sackville Gardens DS0000014153.V260412.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 Sackville Gardens DS0000014153.V260412.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 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 57 Sackville Gardens Address 57 Sackville Gardens Hove East Sussex BN3 4GJ 01273 748031 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) Brighton Housing Trust Vacant Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of service users to be accommodated is five (5). Service users must be aged 18 years or over on admission. Date of last inspection Brief Description of the Service: 57 Sackville Gardens is a small home, which provides care and accommodation for up to five adults aged between 18 years to 65 years with mental health disorders. The home is run by Brighton Housing Trust who also run another small home for people with mental health disorders at 9 Portland Road, Hove and additional supported housing projects in Westbourne Gardens, Leybourne Road, Buckingham Road and Sackville Gardens. The aim of the home is to provide care and support to residents by enabling them to improve their living skills, promote independence, manage their mental health issues and eventually move onto other supported living arrangements. The home is a semi-detached property located in a residential area of Hove, which is within easy reach of local transport, seafront, shops and other amenities. Accommodation is arranged over three floors and consists of four single bedrooms and one self-contained flat. Communal areas include a lounge, dining room, quiet room, kitchen and a small rear garden. The home would not be suitable for residents who have mobility problems, as there are quite a lot of stairs and the service does not have the use of a lift. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Unannounced Inspection was carried out over a period of four hours on 8th December 2005. The inspection process included informal chats with four of the residents and four members of staff, document reading and a tour of the premises. The acting deputy manager assisted the inspector during this process. What the service does well: What has improved since the last inspection? What they could do better:
The home must carry out risk assessments for all four residents who self medicate. This was identified during the last inspection. The home appears to carry out risk assessments in all other areas of resident’s lives, so they really need to address this requirement and ensure that these assessments are
57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 6 reviewed on a regular basis with their support workers. The home must also carry out more regular fire drills with residents. On viewing the records only one fire drill had been carried out and recorded. The bath panel in the first floor bathroom needs repairing. The home has also been asked to carry out a risk assessment in consultation with residents to ascertain as to whether a call bell type of system is required during the night for emergencies only. Issues were raised as to how a resident could alert a sleeping-in night staff member if they were experiencing difficulties, especially if they were living in the top floor flat. 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 Sackville Gardens DS0000014153.V260412.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 Sackville Gardens DS0000014153.V260412.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): 1, 3 & 5 The home has produced an informative residents handbook. All prospective new residents receive a thorough assessment. All residents receive a licensing agreement. EVIDENCE: 57 Sackville Gardens has produced an excellent handbook, which provides residents with information on how the service is run. It includes sections on the programme of support, expectations and boundaries, incident guide, statement of purpose, staffing, communal living, practical issues and complaints. All the initial referrals to the home come via the Mental Health Accommodation Team. Once a referral and all the supporting documentation is received staff from the home will then carry out their own assessment of a prospective resident. Only residents who have a low risk assessment level can be admitted into the home. Once a resident decides to reside in the home a licensing agreement is drawn up between the resident and Brighton Housing Trust. The agreement outlines charges, resident responsibilities and the Trust’s responsibilities to each resident. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 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 the following standard(s): 7&9 Residents have produced their own Bill of Rights. Residents are supported and encouraged to take responsible risks, however risk assessments are not being carried out on the four residents who self medicate. EVIDENCE: Residents have produced their own Bill of Rights, which outlines how they wish be treated, their right to confidentiality and their right to be part of the decision making process. Staff are there, when requested to assist residents in making important life decisions. The ethos of the home is to allow residents to take reasonable risks within a risk assessment framework. Residents and their primary worker discuss responsible risk taking in the areas of health & safety, alcohol, hygiene, diet and being out in the community. The only area the home is not carrying out risk assessments is for the four residents who self medicate. Risk assessments must be carried out for this and reviewed on a regular basis. This was a previous requirement made during the last inspection. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 & 14 Residents are supported and encouraged to develop their life skills. Residents are able to engage in their preferred social activities. EVIDENCE: During their initial assessment, primary workers try to identify and recognise how residents would like to develop their personal life skills. All five residents are involved in attending outside services to improve their skills. Two residents attend a local college; another attends a nearby day centre; whilst another resident attends a local gym and leisure centre most days of the week. Residents are again supported to pursue their own hobbies and interests. Independence is encouraged by residents choosing and arranging their own pursuits. Several enjoy going out to visit their relatives and friends, some like to go out for walks, visit a club, go for a coffee or ten pin bowling. Two of the residents went on a day trip to Amsterdam earlier this year with some residents from the ‘sister’ home at 9 Portland Road. Both residents stated they enjoyed the trip and would like to do further trips in the future. The home is trying to encourage some residents to take a longer holiday but no one has done this yet. One resident stated that he was keen to visit Sweden next year. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 11 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, 20 & 21 Residents do not require assistance with personal care. Risk assessments are required for residents who self medicate. Resident’s wishes are recorded as regards to illness and death. EVIDENCE: All five residents are quite independent and do not require help with their personal care. Staff stated that only two residents needed occasional prompting to change their clothes. Medication issues were discussed with the acting deputy manager who stated that four of the residents now self medicate. Only one resident was selfmedicating at the last inspection. It was noted that no risk assessments had been carried out on the four residents. The home must provide risk assessments for any resident who self medicates and these assessments should be reviewed on a regular basis to ensure that residents are still managing their own medicines. Resident’s wishes regarding serious illness and death are now being recorded in their care plans. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 12 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 home has a policy and procedure regarding the protection of vulnerable adults. EVIDENCE: The home has produced a policy and procedure in-line with East Sussex MultiAgency Guidelines. Staff have attended training in the protection of vulnerable adults. All staff receive a returned CRB check before commencing employment. There are no current adult protection issues within the home. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 13 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): 25, 27 & 30 All bedrooms are for single use and are personalised. There are sufficient toilets and bathrooms within the home. The home was found to be clean and tidy. EVIDENCE: The accommodation at 57 Sackville Gardens consists of four single rooms and one self-contained flat. One of the bedrooms does not have en suite facilities. Recent improvements have included new flooring to one of the bedrooms, a new cooker for the flat and a new fridge and table in another bedroom. Bedrooms appeared comfortable and homely and decorated with residents own personal belongings. Both bathrooms have been refurbished with new flooring and paintwork. They now look much more modern and homely. The bath panel in the bathroom on the first floor needs repairing, as it is loose. Overall the home was found to be clean and tidy. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 14 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): 33 & 34 Residents receive a good level of care from a competent and stable staff team. Staff recruitment files now contain all the required documentation. EVIDENCE: The staff team at 57 Sackville Gardens remains stable. Staff work well together as a team and provide a friendly, supportive and caring environment for residents. Residents who were spoken to on the day also confirmed this statement and felt the staff team provided them with a good level of care and support. Four staff were spoken to informally and they stated that they continue to be happy working in the home. Staff felt the home had continued to be well run under the management of the acting manager. On this particular day the acting deputy manager was in charge with two other project workers. Staff at this home also have designated days to work at other outreach projects run by Brighton Housing Trust. Recruitment files are now complete and include proof of identity and recent photos of all staff members. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 15 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): 37 & 42 The home is currently without a registered manager. Some health & safety concerns were identified during the inspection. EVIDENCE: The long-term manager at 57 Sackville Gardens resigned in September this year. Since then the acting manager has taken over the management of the home. The acting manager is a very experienced worker who has been employed at the home for a number of years. Brighton Housing Trust will be recruiting for the manager’s post in December 2005. Residents stated that there have been no adverse changes to the home since the manager left and it has been running as it usually does. Staff also stated that there had been a smooth transitional period since the manager left. A number of records were viewed and were found to be in order. The home is now maintaining separate records for the supported housing scheme, which is located next door. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 16 During a tour of the premises a number of health & safety issues were identified. Fire drills need to be conducted on a more frequent basis. Although the hot water temperatures are being monitored and hot water blenders have been fitted; temperatures in the first floor bathroom were reaching 47°C plus. It was discussed with the acting deputy manager about whether a buzzer/call bell system should be installed in residents bedrooms, particularly the self contained flat, which is located at the top of the house. How would a resident alert a sleeping-in member of staff if they were experiencing difficulties? It will be requested that the home carry out a risk assessment to ascertain as to whether a call bell type of system would be beneficial to residents during the night. As mentioned previously the bath panel on the first floor needs repairing. The home has addressed some of the damp problems that are occurring in the south wall of the property. Some remaining works are still to be carried out. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X 3 X 3 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X 3 X 3 X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 3 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
57 Sackville Gardens Score 3 X 2 3 Standard No 37 38 39 40 41 42 43 Score 3 X X X 3 2 X DS0000014153.V260412.R01.S.doc Version 5.0 Page 18 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement That an assessment is carried out on all service users who self medicate and that these assessments are reviewed on a regular basis. Previous Requirement That more regular fire drills are carried out and recorded. That the bath panel in the first floor bathroom is repaired. That the home continues to monitor the temperatures of the hot water system to ensure it does not rise above 43°C at any one outlet. Timescale for action 09/12/05 2. 3. 4. YA42 YA42 YA42 23(4)(e) 23(2)(b) 13(4) 09/12/05 31/01/06 09/12/05 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 19 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 YA42 Good Practice Recommendations To carry out a risk assessment in consultation with service users to ascertain as to whether the home requires a call bell system as a means of alerting staff during the night. 57 Sackville Gardens DS0000014153.V260412.R01.S.doc Version 5.0 Page 20 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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