Inspection on 01/11/05 for 8 Restormel Terrace

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Restormel Terrace 25/09/07

8 Restormel Terrace 13/09/06

8 Restormel Terrace 03/03/06

8 Restormel Terrace 18/02/05

8 Restormel Terrace 26/10/04

8 Restormel Terrace 13/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Douglas House 8 Restormel Road Plymouth Devon PL4 6BJ Lead Inspector Margaret Crowley Announced Inspection 1st November 2005 10:00 Douglas House DS0000044469.V259163.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 Douglas House DS0000044469.V259163.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. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Douglas House Address 8 Restormel Road Plymouth Devon PL4 6BJ 01752 253179 01752 253179 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 Regard Partnership Limited Miss Kerry Stephanie Libby Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user over the age of 65 may reside at the home Date of last inspection 18th February 2005 Brief Description of the Service: This service comprises two houses Restormel House at 1a Restormel Terrace, and Douglas House 8 Restormel Terrace. They are located within walking distance of the shopping precinct at Mutley Plain, Plymouth and a short bus ride from the city centre. Both houses provide care for people with a learning disability, although with very different needs. The registered manager for both units is Miss Kerry Libby. Restormel House accommodates 8 service users who may have a severe learning disability and communication difficulties. The property is a large end of terrace house with a lounge and separate dining room and a small patio area at the rear. Douglas House accommodates 4 service users with a moderate learning disability, and who have behaviours that challenge services. The property is a mid terrace house with a lounge and kitchen- dining room and a small patio area at the rear. The premises are not suitable for persons with significant mobility difficulties. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place on 1st November 2005 at Restormel House and 4th November at Douglas House. Tours of the premises took place and records were inspected. Staff were spoken with in the course of their daily duties. Six of the seven service users who live at Restormel House were present during part of the inspection, but because some of them do not have verbal communication their opinions of the service are difficult to gauge. The two service users who live at Douglas House were spoken with. Discussions took place with Kerry Libby, registered manager, who was present in both houses during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Douglas House DS0000044469.V259163.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 Douglas House DS0000044469.V259163.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): 1,2,5 Prospective and current service users do not have important information available, in a form that they can understand, about the facilities and services they can expect. EVIDENCE: The service user guides are not yet available in a form which are accessible to service users in either Restormel House or Douglas House. The statements of purpose should include the room dimensions and information concerning staff currently employed, including their qualifications. A statement of terms and conditions between the Regard Partnership and the service user has not yet been provided for each service user. There have been no new service users admitted since the last inspection. From records inspected and discussions with the manager it was evident that the agency has admission procedures and that comprehensive initial assessments are undertaken. The service users living at Restormel house have lived there for a number of years, but there was currently a vacancy. Discussions were in progress regarding the admission of a new service user at Douglas House. Because of the challenges presented by service users any admissions are paced in the interests of both current and prospective service users. Douglas House DS0000044469.V259163.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): 6,7,9,10 Service users can be confident that their care needs will be met at Restormel House and Douglas House EVIDENCE: Records inspected in both units demonstrated that assessments, risk assessments and care plans are available and reviewed. Daily records are kept for all service users. Some progress has been made with the quality of care planning in Restormel House since the last inspection, but reviews were not all held as frequently as six monthly. The person centred planning approach is not yet in use in either home, but the registered manager said that the agency intends to introduce this and to provide training for staffing in the method. This would promote greater service user involvement in planning and decision making which is more difficult to achieve in Restormel House because of the extent of service users communication difficulties. In Restormel House staff were seen enabling service users to express choices in daily activities. Service user meetings have now been introduced, but these are not held as frequently as monthly. The service users in Douglas House have detailed risk assessments and risk management plans which are produced in consultation with the service users. Evidence was seen in records and observed in interactions with service users of Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 10 a highly individualised approach to the planning of all activities, taking into account the needs and wishes of the service user, their safety, and the safety of staff and the wider community. Service users records were not kept in a locked cabinet in the office of Restormel House. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 11 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): 13,16,17 Service users are consulted and provided with a choice of activities. EVIDENCE: In Restormel House service users are supported in using leisure activities and shops within the local community and beyond. Some service users are enabled to attend college and day opportunities. Service users have an annual holiday, which this year was a self-catering holiday spent at a holiday centre, with the accommodation funded by the Regard Partnership. Service users spoken with were enjoying making plans and shopping for a Halloween party. They are involved in choosing menus, which are displayed. Because of the limitations in the size and facilities of the kitchen, service users have limited opportunity to actively participate in the preparation of meals, drinks and snacks. In Douglas House the two service users in residence at the time of the inspection had very individualised leisure and learning programmes which utilise local education facilities. They are fully involved in shopping and preparing meals and are encouraged to take responsibility for managing their personal food supplies through the week. Evidence of initiatives regarding healthy eating was seen. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 12 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): 18,19,20,21 Service users can be confident that their personal and health care needs will be monitored and addressed. EVIDENCE: Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 13 The changing and declining health care needs of the service users in Restormel House are monitored and reviewed. The service users are aged 45 to 65 and according to the registered manager, some have developed increasing levels of physical dependency. Since the last inspection one service user has died and another was in hospital and not expected to be able to return to the home because of her increased level of dependency. This has had an impact on the service user group who have lived together for several years. The design of the premises makes it unsuitable for service users with high levels of physical needs. The staff team have dealt with the service users deteriorating care needs with sensitivity, ensuring that assistance is sought from the primary care and specialist health care services. The age range of service users in Douglas House is much younger and the care needs very different. The 2 service users in residence at the time of the inspection were mainly independent in personal care other than receiving prompts from staff. The service users have behaviours that challenge services and staff provide support and assistance to enable the service users to develop their social and independent living skills within a risk management framework. Assistance is sought from psychiatric and behavioural services, if necessary. No service users currently self- medicate in either unit. There are satisfactory systems for the storage and administration of medicines. Staff are currently undertaking training in the administration of medicines using a distance learning package, facilitated by the local college of further education. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 14 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): 22,23 Procedures are in place to enable service users to complain and to protect them from abuse EVIDENCE: There have been no complaints since the last inspection. There is a complaints procedure in an accessible format, which is issued to service users. There is an adult protection procedure and the locally issued Alerter’s Guide for staff reference. Although the agency provides some in house training in adult protection, it is recommended that all senior staff attend the multi-agency adult protection training. There are policies available on aggression towards staff, permissible physical intervention, bullying and whistle blowing. There are systems in place for managing service users monies. All service users have their own bank accounts. Records were seen of incoming and outgoing payments. The registered manager has addressed the issue regarding the arrears of Disabled Living Allowance owing to service users from The Regard Partnership. However one service user is yet to be reimbursed. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28,30 Service users in Douglas House live in accommodation that is comfortable and safe. Service users in Restormel House live in accommodation that lacks homeliness and where some safety standards were not met. EVIDENCE: Douglas House was clean, comfortable, and appropriately furnished. It provides an environment of a good standard. Service user rooms are personalised and suited to their needs. The premises are satisfactorily maintained with attention given to service users safety. The hall, stair and dining room carpets are due to be replaced. Restormel House is lacking in homeliness. The lounge does not have comfortable atmosphere and some service users rooms would benefit from redecoration. The kitchen is in need of renovation. The cupboards and work surfaces were chipped and the cooker required replacing. Two of the rings on the hob did not work. The paint on the kitchen ceiling was flaking. Carpets identified required stretching or replacing to prevent a trip hazard. The toilet flooring had an unsightly glue stain and the cupboard in the bathroom needed to be made good. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 16 Both homes have limited outside space. The patio area in Douglas house was attractive and satisfactorily maintained. The patio area in Restormel House was appeared neglected, which limits the service users enjoyment of the facility. Both houses were clean and free from unpleasant odours. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Sufficient skilled staff are employed to meet the high level of needs of the service users EVIDENCE: The two establishments have separate staff groups, but since the last inspection the premises have been re-registered and one registered manager now manages both houses. The current registered manager was the previous manager of Douglas House. Staff are adjusting to the new structure. Staff spoken with were positive about their work. Douglas House staff had found a recent team-building event beneficial. The registered manager said that a similar event was planned with Restormel House staff. This has been a time of transition for Restormel House with the changes in registered manager and deputy manager. A new deputy manager was awaited. The registered manager said that there are sufficient staff employed to meet service users needs by day and by night. Staffing levels are kept under review dependent on the needs of the service users. Restormel House has two waking night staff. Douglas house has only one waking night staff, but the staff member can notify Restormel House for assistance, if necessary, and there is a duty manager on call. Bank staff are employed to supplement the rota when necessary and the registered manager has also worked additional shifts. Few support staff have NVQ qualifications, but all staff were now registered to undertake NVQ3 training. The LDAF framework has been in use previously, but no one was currently undertaking this. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 18 Records were inspected of staff recently employed and provided satisfactory evidence of the recruitment processes. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 19 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): 37,39,42 Douglas House and Restormel House are managed satisfactorily. Service users in Douglas House live in an environment where health and safety standards are met and maintained. Service users in Restormel House live in an environment where some health and safety standards are met and maintained. EVIDENCE: The Registered Manager holds the registered managers award. She has managed Douglas House since it opened and the unit reflects her positive management style. She is attempting to introduce the same approach in Restormel House and recognises that the unit requires support to assist it through the transition of being jointly managed and the changes in staff and the service user group. The Regard Partnership should acknowledge the limitations on her time and not provide her with additional responsibilities in other units outside of her role of registered manager of Restormel House and Douglas House. There is no comprehensive quality assurance system yet in place or an annual development plan. Visits by the responsible individual are not maintained on a monthly basis for each establishment. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 20 Routine health and safety issues are managed satisfactorily and records are maintained up to date and accurate. Fire and accident records were in order. Staff receive mandatory training in first aid and safe working practices. Fire safety training for staff had taken place recently, but not based within the homes. The environmental health officer has identified improvements to be made in the kitchen of Restormel House. The hazardous chemicals cupboard was unlocked in Restormel House. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 21 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 2 3 x x 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x 2 x 3 LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Douglas House Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x DS0000044469.V259163.R01.S.doc Version 5.0 Page 22 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 YA1 Regulation 4 Requirement The statement of purpose and service user guides must be reviewed. The statement of purpose must contain all of the elements required in Schedule 1 of the Regulations. The service user guides must be available in a form accessible to service users. A statement of terms and conditions must be provided for each service user which is signed by the service user or their representative. Any service user who has arrears of Disabled Living Allowance owed to them by The Regard Partnership, must be reimbursed without further delay. Timescale of 20/03/05 not met. Service users records must be stored in a locked cabinet Quality assurance and quality monitoring system must be in place. Visits by the responsible individual must be made monthly and a report sent to CSCI The outside space in Restormel House must be maintained clean DS0000044469.V259163.R01.S.doc Timescale for action 04/04/06 2 YA5 5 04/04/06 3 YA23 10 04/01/06 4 5 6 7 YA41 YA39 YA39 YA24 12 24 26 23 04/02/06 04/04/06 04/02/06 04/02/06 Douglas House Version 5.0 Page 23 and safe 8 9 10 11 YA24 YA42 YA42 YA42 23 23 23 23 Carpets identified must be repaired or renewed The kitchen must be renovated The cooker must be repaired or replaced Hazardous chemicals must be stored safely 04/02/06 04/06/06 04/02/06 04/11/05 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 2 3 Refer to Standard YA23 YA6 YA24 Good Practice Recommendations All senior staff should attend the multi-agency adult protection training. The person centred planning approach should be introduced The lounge and service users rooms identified should have improved decoration and be made more homely. Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 Douglas House DS0000044469.V259163.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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