CARE HOME ADULTS 18-65
7 Princes Crescent 7 Princes Crescent Hove East Sussex BN3 4GS Lead Inspector
Jenny Blackwell Unannounced 20 June 2005 3.30pm The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 7 Princes Crescent Address 7 Princes Crescent Hove East Sussex BN3 4GS 01273 733441 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southdown Housing Association Limited Mr Jon Dimmer Care Home 4 Category(ies) of Learning Disability (LD) 4 registration, with number of places 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of service users accommodated must not exceed four (4). Date of last inspection 15 September 2005 Brief Description of the Service: 7 Princes Crescent is part of the Southdown Housing Association and is registered to provide residence and care to four younger adults with a learning disability. The home is a detached three-storey older style building, situated in Hove. The location of the home offers access to local amenities, including a food shops, pubs and restaurant. Each person has their own individually decorated bedroom. Communal areas comprise of a large lounge and kitchen/dining room. The people do not use the third storey of the property. They attend a local day service, college courses and one person has one to one-day services. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 6 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 people who live at the home, some of the staff team and deputy manager were present during the inspection. Time was spent with four of the people who live at the home. The manager was not present during the unannounced inspection and five staff were spoken to throughout the visit. The requirements made from the inspection in November 2004 were check to see if the they had been met. The deputy manager produced some evidence to show that most of the requirements and recommendation had been met. Some information was unavailable to the inspector and will be reviewed during the announced inspection with the manager. The people who live at the home and the staff were helpful throughout the inspection and contributed to the report where possible. What the service does well:
Daily activities were planned and arranged around each person likes and dislike. During the day all the people either went out or had an activity at home. Staff organised their shifts around the people’s wishes. The staff were seen to interact with each person respectfully and were knowledgeable about their support needs and their preferences. The care plans were well written with comprehensive information about individuals preferred routines during the day. This enabled the staff team to be consistent in their approach to each person. Southdown Housing Association had a comprehensive induction and training programme for new and existing staff. Throughout the day staff were seen to act in a friendly, professional manner with the people. The staff team had training and were experienced in
7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 7 specialist support for the people such as supporting challenging behaviour, autism and supporting people on a 1:1 base. What has improved since the last inspection?
Since the previous inspection Southdown Housing have ensured the manager and deputy have had further training in adult protection guidance. The deputy said he had recently attended a training course that had improved his knowledge. The manager has ensured that exposed hot pipe work has been covered in one person’s bedroom and in the downstairs toilet and shower room. The home was found to be cleaner and kept in better order at this visit. The kitchen and hallway had been decorated and attention had been paid to creating a more homely feel to the kitchen and lounge. New pictures had been put up and new leather settees were in the lounge. The staff spoken to felt that although the furniture had been expensive it would last for longer and be more robust than the previous furniture they had bought. The manager had conducted a survey of the staffing hours allocated to the home. This was required from previous inspection, as the home had run with vacancies and relief staff for some time. The manager forwarded the information to the inspector where he concluded that current staffing levels are adequate to meet the current peoples needs. During the visit staffing levels were observed to be of a level that allowed each person to participate in activities on a 1:1 baseis. The evening meal was prepared whilst the people were engaged in activities with other members of staff. During the evening shift three members of staff were working. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 8 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. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 4. The manager and staff are aware that each person’s placement is reviewed annually. The manager and staff had access to policies and documents that help them to support new people move to the home including visiting the home prior to admission. EVIDENCE: The home has not had any admissions for some time although the information in policy folders indicates that the home has clear admissions procedures. The team review the aspirations of each person with them every six months with input from families and day services. It was noted that Brighton and Hove City Council had not reviewed some people’s placement assessments annually; the last review was conducted in March 2004. It was required the manager ensures each persons assessments are reviewed annually. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 8 Each person’s individual support plans contained information based on their preferences, their likes and dislikes and health care needs. Each plan was generally well written and was presented in the same format. The plans enabled the staff team to work in a consistent manner with each person. EVIDENCE: Three support plans were viewed. The plans contained detailed information about the wishes and support needs of each person. For example one person had detailed information about his preferred routines which staff needed to follow to allow the person to feel confident and safe. The staff were seen to work hard in involving service users in making choices in the home allowing time for service users to make decisions and express their wishes in the communication method they preferred. It was noted that the staff team were particularly skilled at allowing people to lead them in expressing their choices. This required the staff members to give each person time to express their preferences and to use creative methods to understand fully what some people were expressing. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 12 Due to the design of the house and the combination of the four people living together, the manager and team have restricted some parts of the home. The manager had expressed previously these measures where intended to be temporary. Further work is needed to develop other ways in which the people can share the house and also respect each other’s space. Each person had risk assessments in their support plans and these had been reviewed regularly. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15 and 17 The manager and staff were committed in supporting each person with their interest. Personalised activity plans were in place for each individual and the staff were concerned with engaging people primarily on a one to one basis. Each person was actively engaged in their local community and have good links with family and friends. The meals appeared nutritionally balanced and based around the preferences of the people. EVIDENCE: The people are encouraged to maintain the levels of independence that are appropriate for them. They attend a variety of day services, college courses and leisure activities. The manager and staff arrange for people to participate in activities in their local community. The home is set in a residential area and their neighbours know the people. During the day all four of the people were at local day services or had 1:1 sessions with staff. One person had been recycling household waste and had gone for a walk at Devils Dyke. Another person had
7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 14 been to a day service and on his return had gone to the local shop’s with a staff member. Staff arrange other leisure activities that included, going out to concerts and shows, restaurants and pubs. Each person has an active life and enjoys a variety of indoor and outdoor activities. One person went out to a social club that evening. The support plans describe the significant others for each person. Family involvement is encouraged and supported by the staff. One person went to visit his brother during the evening. The manager and staff promote independence and choice for each person. Care is taken by the staff to respect individual’s dignity and privacy, staff were seen to knock on peoples doors and ask permission from them before going into their rooms. The menus were seen and meal preparation observed. The staff prepare the meals and do all the cooking. People are in and out of the kitchen when meals are being prepared and staff engage with them and encourage them to participate. One the day of the visit it was a warm evening and people where asked if they wished to eat outside, this offer was taken up and one person chose to eat his meal in a tent that was set up in the garden. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 19. The people who live at the home are supported to maintain their well being. They attend community health care appointments and have access to specialist health care provision. Preferences in the ways people to receive personal support are recorded. EVIDENCE: Staff were sensitive when supporting people with personal care. They were seen to knock on doors and gain permission before entering. Some people needed support whilst eating and staff were seen to not hurry people whilst eating. Information on how to support people whist receiving personal care was logged in their support plans. Information was available from health care professionals such as from the speech and language therapist. Records were kept of attendance at health care appointments in their support plans. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 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 standard(s) 22 and 23 The organisation’s policies and procedures enable the people who live at the home and their representatives the opportunity to raise concerns and make complaints. The organisation operates within procedures to protect people from abuse. The manager and staff worked in line with the procedures and demonstrated knowledge on their roles and responsibilities in protecting people and reporting suspected abuse. However training gaps in Adult Protection could lead to a reduced knowledge base in staff. EVIDENCE: The complaints procedure was seen during the inspection within the Service User Guide. The organisation has attempted to make the information accessible to those people who don’t read by producing the information in a pictorial format. No complaints had been recorded since the last inspection. During the inspection the staff were asked about their training and understanding of Adult Protection issues. The deputy had undertaken a course for managers that detailed managerial responsibilities in reporting suspected abuse. He stated the course was linked to the multidisciplinary guidelines that operated locally. He was able to go through the procedures he would follow if he suspected abuse. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 17 Another staff member had recently undertaken Southdown Housing’s Adult Protection training for support workers. She found the course useful and felt that the booklet provided was good. A new relief member of staff was yet to train in adult protection but believed it would be covered later in her induction. A check was carried out on the handling of the people’s monies. Appropriate procedures were in place and all staff used the same recording system for each person. Checks are carried out on each person’s money by staff at the change over of each shift. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26 and 30 The home generally met the environmental outcomes for the people. The house was homely in both the shared space and people’s individual bedrooms. The bathroom and shower room were reasonable equipped. All parts of the home were clean and well presented. EVIDENCE: Since the previous inspection several areas of the home have been decorated and up dated. The kitchen and hallway have been painted and modern paintings and photographs have been fixed to the walls. Two leather settees have been bought for the lounge and generally the home was looking more homely. People had their own bedroom. They were decorated in a style that reflected their personality and their interests and hobbies. Two people preferred to keep the room fairly sparse. The staff consulted each person about the style of their rooms as much as possible. Care was taken to ensure that people interest and personalities were reflected in the layout and design of their rooms. The first floor bathroom is in need of updating. The floor was particularly poor. It was required the manager replace the flooring in the bathroom. It was also
7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 19 noted that two window restrictors to upstairs window had broken which needed replacing. The rear garden of the house was large and mature. The people regularly use the garden on good days and during the evening of the visit the two people ate their dinner outside. Some items of furniture were broken and needed replacing. A brick barbeque in the garden had begun to come apart. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, and 35 The staff team were competent in supporting people with disabilities and generally deemed to be effective in their work. The organisations policies and procedures for recruitment of new staff are followed by the home. The people are protected by a robust procedure that meets the requirements in the National Minimum Standards. 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 support staff at Southdown Housing are sponsored to undertake the N.V.Q level 3. One of the staff spoken to had finished his N.V.Q and had found it useful. The manager organised training through individual supervision and through the organisational training plan. The staff received induction within the first six weeks and foundation training within six months. 8 days of training are setaside for each staff member. The staff spoken to during the visit had all received training since working with the organisation. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 21 The staff receive regular 1:1 supervision with either the manager or deputy. This included the relief members of staff. The staff spoken to also found the manager approachable and were confident to raise any issues with him. The staff team meet regularly for staff meetings and have an opportunity to share ideas and raise issues. The manager uses the meetings to share general information from the organisation. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42. The people who live at the home appeared to benefit from a well run home and the staff team had a clear understanding of the leadership’s ethos. The home was generally a safe environment for the people who live and work in the home. Regular health and safety checks are conducted and recorded. EVIDENCE: The home has a comprehensive Health and Safety file and a Health and Safety delegate in the service. Other relevant Health and Safety legislation is detailed in the manual. Staff were aware of the manual and Health and Safety issues. Records were seen where the home checks the fire systems and water temperatures. Since the previous inspection the casing to the boiler has been replace. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 4 x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 3 x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
7 Princes Crescent Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 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. 1. Standard 2 Regulation 14(1) (a,c) 13(4)(a) 13(4)(a) Requirement It is required that the manager ensures the needs of the service user have been assessed by a suitable qualified person. It is required that restrictors are fixed to the windows on the first floor. It is required that the table in the garden is repaired or replaced and some of the garden furniture is replaced. Timescale for action 31st September 2005 Immediate 31st September 2005 2. 3. 24 24 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 26 Good Practice Recommendations It is recommended that the temperature is monitored in one persons bedroom. 7 Princes Crescent H59-H10 S14159 7 Princes Crescent V217921 200605 stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 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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