Inspection on 13/09/06 for 8 Restormel Terrace

This inspection was carried out on 13th September 2006.

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 5 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 03/03/06

8 Restormel Terrace 01/11/05

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 Tina Maddison Key Unannounced Inspection 13 and 15 September 2006 10:00 th th Douglas House DS0000044469.V302539.R02.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 Douglas House DS0000044469.V302539.R02.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. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 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.V302539.R02.S.doc Version 5.2 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 3rd March 2006 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 is registered to accommodate 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 is registered to accommodate 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.V302539.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over two days. The Registered Manager was not available on either day and the Inspector would like to thank the care staff that accessed records and documents as required by the Inspector. A pre inspection questionnaire was not returned prior to the inspection which meant that some information was not available to inform this report. Two service user questionnaires were returned. A site visit of Douglas House was undertaken. During the Inspection one service user was spoken with and two members of staff. Restormel House had no service users resident at the time of the inspection due to refurbishment. A site visit was undertaken and this confirmed the Home was empty and the work is nearing completion. What the service does well: What has improved since the last inspection? Refurbishment has been undertaken in Restormel House that will greatly improve the environment and facilities in the house for service users. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 6 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. Douglas House DS0000044469.V302539.R02.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 Douglas House DS0000044469.V302539.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is poor because pre admission assessments are not undertaken with service users to ensure that Douglas House can meet their care needs. This judgement has been made using all available evidence including a visit to the service. EVIDENCE: All service users had a contract and have a copy of their terms and conditions. A service users guide is available. Restormel House is currently empty and undergoing extensive refurbishment. The Manager has confirmed that when prospective service users are referred to Restormel House then extensive pre admission assessments will be undertaken to ensure that Restormel House is able to meet the prospective service users care needs. One service user had moved into Douglas House from another home in the Regard Partnership. No pre admission assessment was available for this person and has not been forwarded to the commission despite two requests. The service user confirmed that they had not been given a choice of homes and it appears that they were unaware that a choice was a possibility. The service user did confirm that they had an opportunity to visit the home prior to admission and they were familiar with the home, as they had visited service users living there in a social manner in the past. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 9 A revised statement of purpose regarding Restormel House is to be produced prior to the admission of service users following the refurbishment. Douglas House DS0000044469.V302539.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is adequate because service users can make decisions about their lives with assistance as needed. This judgement has been made using available evidence including a visit to the service. EVIDENCE: It was found that all of the service users currently living at Douglas House had care management plans. Three care management plans were examined that detailed care needs and how these would be met. The plans detailed any restrictions on freedom and limitation of choices and detailed agreement from the service user, or their representative or care manager. There were individualised procedures in place in the event of any behaviour that would challenge the service. Each service user has a key worker. There was documented evidence that the care plans were reviewed recently. Service users at Douglas House confirmed that they are encouraged to make their own choices and decisions regarding day-to-day living activities. One service user confirmed that he managed his own money and made choices about what to eat and cooked his meals. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 11 The senior member of staff on duty on the day of the inspection confirmed that service users are included in the day to day running of the home and are encouraged to voice their opinions and service user meetings are regularly held. A risk assessment was available for each service user, and detailed all activities undertaken inside and outside of the home. Evidence was seen that staff had followed the home’s missing persons procedure following the absence of a service user. Douglas House DS0000044469.V302539.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 Quality in this outcome area is good because service users enjoy a range of leisure and educational activities. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service users spoken with confirmed that they are able to take part in college courses and undertake different activities on a daily basis. Other activities enjoyed by the service users were visits to the cinema, and bowling and shopping in the city centre. None of the service users would be able to maintain paid employment due to their learning disability, but one service user said that he enjoyed cleaning cars on occasion to earn some money. Each service user had an individualised daily programme that was drawn up by staff with the service users. Evidence of hobbies and interests were seen by the Inspector in service users’ bedrooms. It was observed during the inspection that staff spoke respectfully to the service users and used their preferred form of address. Service users Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 13 confirmed that staff are friendly and respectful and always knocked on bedroom doors before entering. The service user also confirmed that visitors are welcome to come to the home. Rules on smoking, alcohol and drugs are clearly understood by the service users. Staff commented that Mealtimes are an unhurried and relaxed occasion and sometimes service users eat out during visits to the city centre if they wish to. Menus were examined and evidenced a balanced diet. Service users are encouraged to help with the shopping, preparation and cooking of meals and also the clearing up. None of the service users have special dietary needs, but account is taken of individual likes and dislikes. Three service user questionnaires returned all confirmed that service users liked the meals provided at Douglas House. Douglas House DS0000044469.V302539.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. Service users health and personal care needs are met at Douglas House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users at Douglas House are generally independent with personal care and require only prompting and encouragement from staff. The service users may on occasions display behaviour that challenges the service and staff have sought advice and support from learning disability services to develop a service users social and independent living skills within a risk management framework. Physical Restraints are avoided, and staff use techniques such as distraction and a non-confrontational approach to manage behaviour that challenges the service. There were no records of any physical restraints. None of the service users self medicate. A consent to medication document was not available. Medication records were found to be accurate and appropriately completed. Controlled drugs were found to be stored in accordance with guidelines. Staff spoken with confirmed that they had received appropriate training regarding the dispensing of medication. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 15 Records evidenced that service users’ health is monitored and all service users are registered with a General Practitioner in the area and have regular dental checks. Douglas House DS0000044469.V302539.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good because service users complaints will be listened to and acted upon at Douglas House. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Two Service users stated both in the survey forms and when spoken with at the inspection that they thought that staff listened to their opinions and they thought that if they complained about anything that staff would do something positive to resolve any issue. The service users spoken with knew who to speak to in the event of any complaint or concern. The home has a complaints procedure that is available to service users in an accessible format. There is an adult protection procedure available at Douglas House, and a locally issued alerters guide for staff to refer to. The Regard Partnership provides some in house training in adult protection. Two staff members that were spoken with during the inspection were familiar with the homes whistle blowing policy and felt able to use it if necessary. Physical interventions and restraints are only used as a last resort and staff have received training in this area. Verbal aggression from service users is understood, and staff felt able to deal with this appropriately. All service users have their own bank accounts, and manage their money with assistance from staff. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 17 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): 24,30. Quality in this outcome area is good because service users at Douglas House enjoy a homely, comfortable and safe environment. This judgement has been made using all available evidence including a visit to the service. EVIDENCE: At the time of the Inspection, Restormel House was nearing completion of the refurbishment and no service users were in residence. A tour of Restormel House evidenced that the home has been refurbished and redecorated and new furniture has been purchased. It is anticipated by staff that Restormel House will be ready to admit service users shortly. Douglas House was found to be very clean, homely and comfortable on the day of the inspection. This home is not suitable for service users who have limited mobility, as it is a Victorian property with steep stairs and steps leading up to the front door. There is a small courtyard to the rear of the property. Douglas House has adequate bathroom facilities and one service user has an en suite bathroom. All were found to be clean and hygienic. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 18 The Registered Manager was not available on both days of the inspection, and it was not known by staff if there is a planned programme of maintenance and renewal. Service users’ bedrooms were found to be individualised and reflected personal interests and tastes. The two service users spoken with said that they liked their bedrooms and were very happy with them. The lounge and dining area were comfortable and well furnished. The kitchen is fully accessible to the service users. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate because service users are supported by an effective and well-trained staff team. This judgement has been made using all available evidence including a visit to the service. EVIDENCE: Restormel House and Douglas House have separate staff groups. When Restormel opens for service users new staff will be recruited. Douglas House staff were positive about their work and staff spoken with stated that they enjoyed working there. Staff said that they received supervision on a regular basis from the Manager. They were clear about their roles and responsibilities. Staffing rotas evidenced that there are between three and six staff on duty at all times depending on service users care needs. At nights there is one waking night staff with the back up of an on call Manager, and the support from other staff working at the Regard Home close to Douglas House. As no pre inspection questionnaire was received from the Manager prior to the inspection, and the Manager was not available at the times of the visits to the home, the inspector was not able to ascertain if there was any training programme and how many of the staff are qualified to NVQ level. This will be followed up at the next inspection. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 20 Staff spoken with confirmed that they thought that they received appropriate training in areas such as medication, physical intervention and first aid. Minutes were seen of staff meetings. Three staff files were examined, and evidenced that two of the files contained two references, and one contained only one reference. All had proof of identification and an application form. Two out of the three did not contain evidence that a CRB check had been obtained Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate because some decisions regarding the day-to-day running of the home and affecting the service users have not been communicated to the Commission. The management of health and safety in the home is generally good but the health and safety of service users could be affected by some shortfalls in health and safety checks. This judgement has been made using all available evidence including a visit to the home. EVIDENCE: The Registered Manager holds the Registered Managers award, and has relevant experience working with people who have a learning disability. The Regard Partnership has a quality assurance department who undertake the regular regulation 26 reports. Questionnaires have been devised for residents, relatives and care managers to assess the quality of the care provided at the home. Routine health and safety documents were examined. This evidenced that fire training for staff was last undertaken in April 2006 and must be provided in line with current fire prevention regulations. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 22 Windows were fitted with restrictors, and radiators have been covered. Records of electrical portable appliance testing were unable to be found. Accident records were appropriately maintained. Staff had received mandatory training in first aid and safe working practices. All hazardous substances were safely stored, and risk assessments were in place for all activities undertaken in the home, and for all areas of the home. The Commission for Social Care Inspection were not notified that service users were moving out of Restormel House and that it was to remain empty whilst being renovated. The Regard Partnership did not supply the Commission with documents relating to the service users involved as requested. A pre inspection questionnaire was not returned prior to the inspection which meant that in the absence of the Manager during the inspection some information was not able to be obtained that would inform the outcome of the inspection in certain areas. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 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 Standard No Score 1 2 2 1 3 3 4 3 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 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 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 YA1 Regulation 4 Requirement The Registered Manager must supply to the Commission a copy of the statement of purpose for Restormel House. An assessment of care needs must be undertaken before a service user is admitted to the home. The home’s recruitment procedure must include obtaining two written references and a current CRB check. All portable electrical appliances must be regularly tested. The registered person must give notice to the Commission of any event in the care home that adversely affects the well being of any service user. Timescale for action 30/11/06 2 YA3 14 30/10/06 3 YA34 19 30/09/06 4 5 YA42 YA43 12 37 30/11/06 30/10/06 Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 25 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 YA20 Good Practice Recommendations A consent to medication document agreed by each individual service user should be put in place. Douglas House DS0000044469.V302539.R02.S.doc Version 5.2 Page 26 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. 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