Inspection on 22/02/08 for 74 Sir Evelyn Road

This inspection was carried out on 22nd February 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

74 Sir Evelyn Road 01/11/06

74 Sir Evelyn Road 01/02/06

74 Sir Evelyn Road 28/09/05

74 Sir Evelyn Road 24/03/05

74 Sir Evelyn Road 12/05/04

74 Sir Evelyn Road 03/12/03

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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 74 Sir Evelyn Road 74 Sir Evelyn Road Rochester Kent ME1 3LZ Lead Inspector Kim Rogers Unannounced Inspection 22nd February 2008 12.30 74 Sir Evelyn Road DS0000040213.V357777.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 74 Sir Evelyn Road DS0000040213.V357777.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. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 74 Sir Evelyn Road Address 74 Sir Evelyn Road Rochester Kent ME1 3LZ 01634 828779 01634 828779 sir.evelyn@robinia.co.uk 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) The Robinia Care Group Ltd None Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th March 2007 Brief Description of the Service: The home is registered to provide personal care and support to a maximum of six people who may have a learning disability. The home is detached and situated in a quiet residential area near to Rochester Town Centre, and has easy access to the local bus route. The home also has its own transport that is used to access community facilities. The accommodation comprises of a large communal lounge, dining room, kitchen, laundry room, toilets, bathroom, and office. It has six bedrooms (four of which are en-suite). One of the bedrooms is on the round floor. There is a private garden that can be accessed from the large conservatory. The fee for this home ranges from £1400 to £1750 a week. For more information about the fee and what it includes please contact the Provider. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection site visit was unannounced and carried out by one inspector over about 4 hours. Work was carried out before the inspection including surveying service users, staff, care managers and relatives. An Annual Quality Assurance Assessment (AQAA) supplied by the manager and other information was analysed. Homes are now required to complete an AQAA every year. It gives lots of information about the home and about how the home plans to improve. The inspector spent time with service users individually and as a group, spoke to staff and the manager, and made observations. A service user and a member of staff showed the inspector around the home and some records were sampled. The requirements made at the last inspection have been met. There is one outstanding recommendation. Service users said that they feel safe and looked after. Service users said they have things to do and know who to talk to if they have a problem. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: What has improved since the last inspection? After a period without a manager, the home now has a permanent manager who is qualified and experienced. The manager should complete his application to be the Registered Manager without delay. There is a spacious conservatory at the back of the house overlooking the garden. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 6 Supervision of staff is now in place as required at the last inspection. The range of training offered to staff has increased to include subjects relating to service users needs including person centred planning and active support. The requirements made at the last inspection have been met. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 74 Sir Evelyn Road DS0000040213.V357777.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 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 1 and 2 People who use the service experience adequate outcomes. Service users know that their needs will be assessed and supported. More needs to be done to establish and support people’s aspirations. Information about the home should be updated so people have the information they need to make a decision about the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose and Service User Guide. Both are general to the company providing the support and give little detail about the home. For example one document says each home has a manager and staff team but does not give details about the manager and staff team of 74 Sir Evelyn Road. The manager said that some of the statements made in the documents are out of date and no longer relevant. Although there are some symbols the documents are not in a suitable format for everyone to understand. This means that prospective service users may not have the information they need to make an informed decision about moving in. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 9 Two service user plans were sampled. Both had needs assessments by care management. One had an assessment carried out by the home. Aspirations were not included in this assessment. One service user plan had a personal goal recorded but there was no plan to support this. The manager said there are plans to introduce a more person centred assessment. 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 6, 7 and 9 People who use the service experience adequate outcomes. People cannot be sure their personal goals and aspirations will be identified and supported. Communication could be better supported giving people more control over their lives. Service users are supported to take risks although strategies to support risk taking could be more enabling. Problem behaviours could be better supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a care plan with ‘treatment plans’ These are written with no evidence of service user involvement. Plans are not person centred. Needs are recorded with action staff need to take to meet the assessed needs although information is basic. Two service user plans were sampled. One had no mention of any personal goals or aspirations for the future. The other had a personal goal recorded but there was no path or support plan in place to help achieve this goal. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 11 The two people sampled both had a second file. This is more person centred with pictures and photos and information about the person presented in a way they can understand. This is very much work in progress. Person centred planning is not embedded in this home but at a very early stage. The manager said that more staff training is planned. Although some people have problem behaviours, details in support plans are limited. There are no support plans for some problem behaviours. There are no functional assessments so it’s not been established why people present some behaviours. One plan said to distract the person but it was observed that staff were not always around to distract. The manager said that the directions to staff in one plan were out of date. There are risk assessments in place with a focus on keeping people safe. The manager said that these would be reviewed to ensure people are supported to take risks. Limitations on choices and facilities should be reviewed. For example the kitchen remains locked off to people and this may not be the least restrictive option. There is no evidence that this decision was agreed with people who use the service. Most people have significant communication needs and use alternative methods of communication including Makaton. Staff need the skills to communicate with service users to support choice making and control. Not all of the staff team have these skills, therefore areas where people can affect change are limited. 3 out of 15 staff have recently attended Makaton training. No staff was observed using Makaton during the inspection. One staff said they only had basic knowledge. The environment could better support communication, for example, service users do not know who will be on duty, what activities are on offer and what’s for dinner unless staff tell them. Staff have started work on individual ‘communication passports’ with service users. One staff discussed this and showed the draft document. Staff plan to complete these for all service users to increase communication opportunities. 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 12,13,15,16 and 17 People who use the service experience adequate outcomes. Service users have opportunities and the support they need to access community facilities. In house activities and participation levels could be increased. Service users have a balanced diet but don’t have control over the menu and choices. Service users are supported to make friends and keep in touch with friends and family. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. Service user plans could better reflect the support needed to develop skills. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 13 People using the service are given the opportunity to take part in a variety of activities mainly in the community. During the visit people arrived home from horse riding and shopping. Where possible staff gathers information on community based events and try to make individual arrangements for people to attend. One staff said they are trying to arrange a college course for one individual. Activities in house are limited. No plans were seen to develop independent living skills so the maximum potential of people has not been recognised. Staff deployment could be more effective to support this. The kitchen and laundry remain locked although staff said some people do help with basic cooking. Staff said that they do most of the cooking and cleaning. This means levels of engagement and participation for people who use the service are low. This was observed during the visit. The menu for the week’s evening meals is written and displayed in the kitchen. This is not in a format that everyone can understand. No alternative meal was recorded. Records show that the food people have is balanced. Staff support links with family and friends. 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 18,19 and 20 People who use the service experience good outcomes. Personal and health care needs are recorded and supported. Medication practice is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs and preferences are recorded in service user plans. This ensures people get the support they need. Most of the bedrooms have en suite facilities. One person has a shower and would like to access the first floor bathroom. The manager and staff are working with other agencies to try to make this happen. Health needs are recorded in individual plans although some lack detail. Staff said they had to ask other staff about a health need as some detail was missing from the person’s plan. This needs addressing as could be potentially serious. People have access to a range of health care services in the home and in the community. The home works closely with health professionals to support 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 15 people’s needs. The manager plans to introduce health action plans for individuals. Since the last inspection the manager has reviewed medication practices. Staff now check medication stocks and records as part of the handover. No one controls his or her own medication. The manager said staff try to give people as much control as possible. The requirement relating to medication practice made at the last inspection has been met. 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 22 and 23 People who use the service experience good outcomes. Service users are safeguarded from harm but more could be done to ensure people have the support they need to communicate complaints and disclosures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a policy and procedures in place to safeguard vulnerable adults. Staff have training in recognising and responding to abuse. Staff have regular supervision meetings and are aware of who to report any concerns to. Training is also available in supporting challenging behaviours. Staff were observed using distraction and diffusion techniques. The manager plans to introduce support plans based on Positive Behaviour Support techniques. At present plans are basic and not based on any functional assessments. There is a complaints procedure but it is not produced in a format that everyone can understand and not everyone has a copy. There are opportunities for people to complain about the service including service user meetings although more could to be done to increase communication. All of the service users surveys received said people feel safe at the home and are happy with the service. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 17 At present no one controls their own money. The manager says there is potential for some people to have more control over their money and has plans to support this. Some restrictions on facilities have been made with no evidence of service user involvement and agreement. For example the kitchen and laundry are locked. The manager agreed to review imposed restrictions in consultation with the people who use the service. 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 24 and 30 People who use the service experience good outcomes. Service users live in a clean, safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector had a look around the home. There have been some improvements to the environment since the last inspection. Some redecorating has taken place and a new large conservatory erected at the back of the property. This enables service users to have a lot more communal space. The environment is appropriate to the specific needs of the people who use the service. One person showed the Inspector his bedroom, which was personalised and individual. All bedrooms are single. Most of the bedrooms have en suite facilities. There are also communal bathroom and toilet facilities. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 19 Staff said they generally do the cleaning missing an opportunity to develop service users skills. The home was clean and tidy on the day of the visit. There is a secluded garden to the rear of the property. The manager said that each person has a front door key but that no-one has a key to their bedroom. Staff can lock doors from the outside, which can be overridden from the inside. This means staff have control and people have to ask for their rooms to be unlocked. Every service user survey said that people like living at 74 Sir Evelyn Road. 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 32,34 and 35 People who use the service experience adequate outcomes. Service users are supported by sufficient trained staff who are properly supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection some new staff have been recruited so the home has its full complement of staff. There are 3 staff on duty during the day and 2 staff on duty at night. However there were times during the inspection when staff were busy in the office and service users were left to their own devices. One person needed support during this time but had to wait until a member of staff noticed. Thought should be given to how effectively staff are deployed. One new staff talked about their induction and said they have a supportive mentor. The manager has been supervising new staff and plans to carry out three-month reviews. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 21 New staff said they had the opportunity to meet service users and other staff during visits and trial days at the home before they started in post. Staff confirmed they have contracts and job descriptions. Recruitment checks are carried out before a person starts. There are plans to support some service users to be part of the recruitment process. Staff said supervision has improved with all staff having regular meetings with the manager. There is a rolling programme of training that staff can access. The in house training coordinator assesses training needs. Training is related to service users specific needs. Due to the demands of the service, only two or three staff at a time can attend training. Therefore not all staff have had the training they need including Person Centred Planning, Makaton and managing challenging behaviours. The manager has recognised this and other barriers and has plans to overcome them. The manager said staff use to ‘do for’ but with training and support they now try to ‘do with’ 74 Sir Evelyn Road DS0000040213.V357777.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): Standards 37,39 and 42 People using the service experience good outcomes. The home is adequately managed and managed in service users best interests. Health and safety is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for over six months and is in the process of applying to the Commission to become the Registered Manager. The manager has several years experience and has a National Vocational Qualification at level 4. The manager spoke with knowledge and understanding of service user needs and was observed interacting with service users positively and respectfully. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 23 Service users were at ease with the manager. The manager is person centred in his approach and recognises equality and diversity issues. The manager has identified where the service needs to improve and has also identified barriers to improvement. He has ideas and strategies about how to overcome these barriers. Staff commented positively about the new manager. The manager returned the Annual Quality Assurance Assessment (AQAA) to the Commission as required. The document was generally well completed but there was a lack of evidence to demonstrate that the home is good value for money. The range and detail about how service users views are sought and acted on was limited to meetings and questionnaires. There was a lack of good quality evidence to show how improvements have been made to outcomes for service users following consultations. However, the Inspector heard about some good examples during the visit. The company carry out monthly quality audits at the home and produce a report with an action plan. Staff supervision has improved. Staff said they have regular supervision meetings with the manager. The manager said he is supported by an area manager and has regular supervision as well as support from other home managers at managers meetings. The home is well maintained and safe for the people who live there. The AQAA shows that the required health and safety checks are completed. The health and safety information poster in the kitchen needs updating. 74 Sir Evelyn Road DS0000040213.V357777.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 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 25 None 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 YA19 Regulation 12 Requirement Timescale for action 31/03/08 2. YA16 16 3. YA6 15 Ensure that health needs are recorded in enough detail so staff know what action to take to meet these needs. Review imposed restrictions after 30/04/08 consultation with service users, including the kitchen and laundry being locked. Ensure that personal goals and 31/05/08 aspirations are identified, recorded and thoroughly supported in individual person centred plans. 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 YA1 Good Practice Recommendations That the home’s Statement of Purpose and service User Guide be reviewed and updated. 74 Sir Evelyn Road DS0000040213.V357777.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South East Region 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 74 Sir Evelyn Road DS0000040213.V357777.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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