Inspection on 15/08/07 for 68 Gayhurst Drive

This inspection was carried out on 15th August 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

Dovedale Court

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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 68 Gayhurst Drive 68 Gayhurst Drive Sittingbourne Kent ME10 1UD Lead Inspector Eamonn Kelly Key Unannounced Inspection 15th August 2007 4:15 68 Gayhurst Drive DS0000067420.V345723.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 68 Gayhurst Drive DS0000067420.V345723.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. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 68 Gayhurst Drive Address 68 Gayhurst Drive Sittingbourne Kent ME10 1UD 01795 428595 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of manager Type of registration No. of places registered (if applicable) MCCH Society Limited Mrs Joan Nicholls Care Home 2 Category(ies) of Learning disability (2) registration, with number of places 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One resident over the age of 65 years. Date of last inspection 22nd June 2006 Brief Description of the Service: The MCCH Society Ltd website www.mcch.co.uk says the purpose of the organisation is to support people to live full and valued lives. It provides “a range of services (in London and the South East) for people with disabilities which includes learning disabilities, mental illness, autism, Asperger’s Syndrome and other complex needs”. The premises, with accommodation for two residents, are near Sittingbourne town centre. Weekly fees are £1428. Additional charges are made for hairdressing, private chiropody, aromatherapy, hydrotherapy, costs of social activities excluding transport costs and costs of one-off meals for certain occasions. The cost of the vehicle is covered for the next 2 years from resident’s disability living allowances. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 15th August 2007 (4.15-8.30pm). It consisted of meeting with the manager (Joan Nicholls), residents and a member of staff. Care practices were observed and discussed. A variety of records was seen during the visit principally those that supported the care of residents. The manager provided the commission with a completed annual quality assurance assessment (AQAA) and this has been helpful in preparing this report. The improvements requested in the previous inspection report have been addressed or are close to completion. What the service does well: What has improved since the last inspection? What they could do better: The premises are suitable for supporting residents and re-decoration of parts of the premises is planned. Pre-admission written documents (resident’s and relative’s guide and personal contracts) are under review and updated copies are necessary for any future admissions. Some redecoration of premises is advisable. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 6 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. 68 Gayhurst Drive DS0000067420.V345723.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 68 Gayhurst Drive DS0000067420.V345723.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): 1, 2, 5. People who use the service experience poor quality outcomes. This judgement was made using a range of evidence including a visit to the service. The lack of a good resident’s guide and accurate personal contract is unhelpful for prospective residents and their supporters at admission stage. EVIDENCE: The manager, Mrs Joan Nicholls, is aware of the need for a good pre-admission guide (based on the information listed in Schedule 1 of Care Home regulations) and personal contract and she is committed to producing (or improving) both. Residents have lived at the home for many years and it is unlikely there will be immediate need for these documents to be available for new placements. Nevertheless, they are necessary and the manager says they will be available within the next 3 months. In the event of any new admission, the manager would ensure that services and procedures are such that new resident’s support needs and aspirations would be identified and met. The revised personal contract would, the manager says, contain information about each resident’s needs as identified at preadmission stage and how these were intended to be addressed. This would be a departure from how current personal contracts are prepared by MCCH 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 9 Society Ltd. For example, the manager is currently identifying costs that can be legitimately and appropriately charged to residents as additional costs and what is included in weekly fees. This information needs to be clearly written in pre-admission written documents and procedures should be in place to ensure that the policy is adhered to on a day-to-day basis. 68 Gayhurst Drive DS0000067420.V345723.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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are helped to make decisions and to express themselves as part of developing their confidence and quality of life. EVIDENCE: Residents are encouraged to make their own decisions and choices. Members of staff understand the importance of doing this. Care plans and associated procedures are person centred and are agreed using a number of forms of communication with residents. Plans are easy to understand and look at all areas of each resident’s life. Members of staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. They use a variety of ways to help individuals make a worthwhile contribution. Residents were relaxed and at ease during the inspection visit. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 11 The care plan is seen as a working document reviewed regularly. It is kept up to date and focuses on how residents develop their skills and have their future aspirations recognised and addressed. The manager and member of staff on duty say that they are endeavouring to reduce the amount of paperwork and records stored so that records contribute more fully and directly to resident’s well being and health. Each care plan includes a risk assessment. The examples discussed address safety issues whilst aiming to maintain good qualities of life. The manager is aware of current policy issues and good practice developments. She outlined how she is transferring this thinking into the daily work of support staff so that the actions of residents are understood in all circumstances and reasons for action/reactions taken into account. 68 Gayhurst Drive DS0000067420.V345723.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): 12-17. People who use the service experience excellent quality outcomes. This judgement was made using a range of evidence including a visit to the service. Routines and activities developed with each resident give them opportunities to develop their skills and exercise preferences on a day-to-day basis. EVIDENCE: The promotion of each resident’s right to live an ordinary and meaningful life is central to the home’s aims and objectives. Members of staff understand the importance of enabling residents to achieve their goals, follow their interests and be integrated into community life and leisure activities. Residents are able to enjoy a full and positive lifestyle with a variety of options to choose from. Residents’ interests and abilities are known and reviewed. These are taken into account when planning routines of daily living and 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 13 arranging activities both in the premises and the community. Routines are flexible and residents make choices in major areas of their life. Routines, activities and plans are resident focused, regularly reviewed, and can be quickly changed to meet individuals changing needs and wishes. The availability of a vehicle assists with this flexibility. The ability of staff to understand what residents mean and feel, despite the lack of resident’s ability to verbally communicate, also benefits residents and enables routines to be varied. Members of staff encourage and provide imaginative and varied opportunities for residents to develop and maintain social, emotional, communication and independent living skills. The manager outlined effective methods that focus on involving residents in all areas of their life and promotes their rights to make informed choices. This includes links to specialist support when needed and opportunities to develop and maintain family and personal relationships. There is evidence of innovative methods being used. This includes prediction of factors that may cause upset to residents and ways of alleviating future distress. The evidence is that residents are enjoying the opportunities that they experience. Residents are helped to be independent and are involved in all areas of daily living in the home. This includes taking some part in and responsibility for shopping, planning meals, and meal preparation. Each resident has a separate menu planner and they are encouraged to help with its implementation. The evening meal was relaxed and residents helped with some aspects of preparation. Food and meals form a part of each resident’s care plan. 68 Gayhurst Drive DS0000067420.V345723.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): 18-21. People who use the service experience excellent quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents receive excellent personal and healthcare support. EVIDENCE: Residents receive effective personal and healthcare support. The proposed new Resident’s and Relative’s Guide will set out the competencies and specialisms the home offers and delivers through a skilled and knowledgeable staff group working in a person centred way. Resident’s individual plans clearly record their personal and healthcare needs and outline how these will be delivered. Members of staff ensure that personal support is flexible, consistent, and is able to meet the changing needs of residents. They know and respect resident’s preferences. Male, female and age related issues are taken into account when delivering personal care. On this occasion, members of staff 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 15 responded sensitively in situations involving personal care ensuring that they were conducted in privacy. There are no specific aids and equipment provided but these would be considered to encourage maximum independence for residents. Residents receive good healthcare support. This includes access to a GP, mental health nurses and all NHS healthcare facilities in the local community. Regular appointments are seen as important and systems are in place to ensure they are not missed. The home arranges for health professionals to visit residents at home when necessary. Much emphasis was placed during this inspection visit on how members of staff are encouraged to be alert to changes in mood, behaviour and general wellbeing of residents and to understand how they should respond and take action. Health action plans are being developed in line with current good practice guidance. Efficient medication policy, procedure and practice guidance has been developed. Members of staff understand their role and responsibilities. Medication records are seen as important to the efficient management of health care matters and these are kept up to date. The home has a good record of full compliance with the administration, safekeeping and disposal of controlled drugs. Although none are currently in use, the appropriate method of storage and recording has been retained. The service is efficient when caring for residents who are terminally ill or dying. The home has a detailed policy, procedure and practice guidance to help staff when caring for residents with degenerative conditions, terminal care and death. Members of staff receive in house training and practical advice and have continuous support and opportunities to discuss any areas of anxiety and concern. 68 Gayhurst Drive DS0000067420.V345723.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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are protected from abuse. EVIDENCE: Residents express themselves in ways that members of staff understand. Their paths of transition from previous lifestyles indicate that they have been effectively assisted in becoming confident and trusting. The manager and staff regard their safety and protection as a priority. The service has a complaints procedure that easy to understand. It is displayed at the premises albeit in a slightly obscure way. This is because notices are placed on walls in a disorganised way. It is expected that the revised Resident’s and Relative’s Guide will refer to the importance of resident’s security and protection in an appropriate way. Whilst visitors and others are encouraged to make their views about the service known, there have been no substantive complaints received over the past year. The policies and procedures for safeguarding adults are available and give specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. The manager understands the procedures for Safeguarding Adults and, if necessary, would attend meetings or provide information to external agencies. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 17 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 18 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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. The premises are suitable for the support of residents. EVIDENCE: Residents are encouraged to personalise their bedrooms and they have done so effectively. The premises’ fixtures and fittings broadly meet the needs of the individuals. The shared areas provide good communal space with opportunities to meet relatives and friends in private. The premises provide a physical environment that is appropriate to the specific needs of the people who live there. The home is a safe place to live; the bedrooms, communal areas and external facilities meet national standards. Each resident has a single bedroom. There is a first floor bathroom and ground floor shower room. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 19 The home is in some need of re-decoration and this is planned. Members of staff follow procedures required by the manager to reduce the risk of infection. All members of staff are provided with an excellent health and safety manual/CD to assist with the safe conduct of the home. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents are in the care of members of staff who are well supported by the company and by the manager of the home. EVIDENCE: The staffing arrangements are built around having a member of staff with both residents during the night and in the earlier part of the morning and in the evening. During the day, two members of staff are on duty. On some evenings when residents go out, two members of staff attend. The member of staff on duty at night has a first floor bedroom and residents do not need a member of staff awake at night for their safety and protection. These arrangements, according to Mrs Nicholls, enable residents to enjoy a good lifestyle and the viability of the home is protected. Members of staff are encouraged to undertake NVQ Levels 2 and 3 in Care and all have now achieved this qualification. The induction procedure followed is 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 21 suitable for this staff group and it covers the standards required by the relevant training agency for the care sector (Skills for Care). Members of staff undertake additional training appropriate to the needs of residents at the home. The records seen indicate that very good progress in this area has taken place over the past year. The annual quality assurance assessment (AQAA) also outlines the progress made and plans for achieving a full training profile for each member of staff. These are discussed in formal supervision meetings between the manager and individual members of staff with a record of the outcome agreed and maintained. Because of the relevance of the subject of dementia in this setting, Mrs Nicholls is considering the possibility of enabling staff (who wish to) to achieve the RVQ Certificate in Dementia Care. It is reported that in other parts of the company residents are involved in the recruitment process. This part of the company has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff met confirmed that the service is clear about what is required at all stages. There are contingency plans for cover for vacancies and sickness with some use of agency and “bank” staff. All members of staff have a CRB/POVA check before being employed. The manager is obtaining a list of all staff CRB reference numbers, date of the check and the outcome. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 22 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. People who use the service experience good quality outcomes. This judgement was made using a range of evidence including a visit to the service. Residents have the benefit of living in a home that is well run and that has the support of a wider organization. EVIDENCE: Mrs Nichols has achieved NVQ Level 3 in Health and Social Care, is an NVQ assessor and has certificates in infection control, safe administration of medication and dementia care. She has wide experience in the provision and management of residential care of people with learning and physical disabilities. She plans to undertake the RMA soon. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 23 The manager works to continuously improve services and provide an increased quality of life for residents and is aware of current developments both nationally and by CSCI and plans the service accordingly. The home has good policies and procedures that the manager is reviewing and updating. Care plan records are being improved so that each is relevant to the support needs of the resident. Other documents referred to elsewhere in this report are being improved. Management processes ensure that members of staff receive feedback on their work and they are well supported. The home works to an excellent health and safety policy: all members of staff are aware of the policy and are trained to put its theory into practice. Safeguarding is given high priority and the home has a range of policies and guidance to underpin good practice. There is evidence of organisational monitoring by the corporate providers (MCCH). Since the purchase of the home by this provider procedures and policies have changed. It is reported that managers have sufficient autonomy to run homes within corporate guidelines but with an emphasis on individual quality support for residents. As part of devolved responsibilities, the manager ensures risk assessments are completed and taken into account in planning the care and routines of the home. The manager (whose registration with the commission is pending) has the skills and ability to deliver good business planning and effective financial controls. An example is the work the manager has undertaken in separating out the items that are included in weekly fees and those that are additionally and properly charged. These will be fully clarified in the revised residents/relatives guide and new personal contract. 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 24 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 1 2 3 3 x 4 x 5 2 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 4 3 x 3 x x 3 x 68 Gayhurst Drive DS0000067420.V345723.R01.S.doc Version 5.2 Page 25 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 YA1YA1 YA5YA5 Regulation 4, 5, 6. Requirement Pre-admission written information should be improved so that services and facilities specific to this residential home are described. As part of this improvement and to assist prospective residents and their supporters, new personal contracts should be devised. Timescale for action 01/12/07 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 68 Gayhurst Drive DS0000067420.V345723.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 68 Gayhurst Drive DS0000067420.V345723.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. 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