Inspection on 25/09/07 for 8 Restormel Terrace

This inspection was carried out on 25th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

8 Restormel Terrace 13/09/06

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 Elaine Bruce Unannounced Inspection 25th September 2007 10:15 Douglas House DS0000044469.V344090.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 Douglas House DS0000044469.V344090.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. Douglas House DS0000044469.V344090.R01.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 Ltd Miss Kerry Stephanie Libby Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Douglas House DS0000044469.V344090.R01.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 13th September 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.V344090.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection at Douglas House and Restormel House took place between the hours of 1015 and 1615 on the 26th September 2007. The registered manager for both the homes was on duty and assisted the inspector during the course of the day. The homes are located a short distance away from each other and the registered manager is generally based at Douglas House with one of her deputy managers based at Restormel House. She is fully aware of her responsibilities in law for both homes. It is though essential that the organisation ensures that the certificate of registration is amended to reflect the correct number of beds that are to be provided for each service. It is understood that although the registration is at this time for 12 beds it needs to be reduced to 10 beds following the refurbishment at Restormel House. Prior to the inspection a completed annual quality assurance document was received from the home and a large number of survey forms. Five survey forms were received from the people in the home(s), some completed with support from their next of kin and nine staff survey forms were also received. The surveys indicate that the people in the home are satisfied with the standard of care that they are receiving at the home and the staff indicate a satisfaction with the standard of the care they are delivering and feel that they are a valued employee. During the course of the day people were spoken to in both of the homes, this was in between the busy comings and goings of each home. In addition an inspection of communal areas of both homes took place as did an inspection of the care plans and associated records, the staffing files, the medication arrangements and the meals provided. The weekly cost of care is from £1929:18 to £2158:76 What the service does well: The staff and management team are committed to delivering a good service that respects the choices and aspirations of the people in the home. The philosophy of the home is to support the people in the home to develop skills to allow them to reach a level of independence through guidance and support from the staff. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 6 Survey forms received from the people living in the home, conversations with them and observations during the course of the inspection would suggest that the people in the home(s) enjoy living there. Each home provides individualised care programmes for each person and deals in a professional and skilled manner when behaviours challenge the service. Staff on duty at the time of the inspection were observed to have a positive and enabling relationship with the people in both homes. 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. 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. Douglas House DS0000044469.V344090.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 Douglas House DS0000044469.V344090.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough and comprehensive procedures prior to admission ensure that the people in the home (and their representatives) can be confident that their needs will be met. EVIDENCE: Douglas House and Restormel House are not fully occupied at this time. Extensive refurbishment has recently taken place at Restormel House resulting in the closure of the home during this time. There are two people now living in the home with plans for there to be six people living there when the home is full. At Douglas House there are three people living there with one vacancy. The certificate of registration for the total number of people in the home is incorrect and requires a variation to ensure that the number of beds registered is correct. The organisation must address this as a priority with the Commission for Social Care Inspection. The pre admission assessment of a recent admission to Restormel House was inspected along with the funding authorities’ assessment. The pre admission procedure for both of the homes is very thorough. The original assessment of care needs is undertaken by the manager and her deputy. Visits to the home Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 9 are arranged slowly over a period of time to ensure that the whole admission process is thorough and in the best interests of the person being admitted to the home. Once a placement takes place it is treated as temporary initially for the first eight weeks in the best interests of the person being admitted to the home. A revised statement of purpose document and service user guide is in place for both Douglas House and Restormel House. The document has been made very “user friendly” for the people in the home to include it being available on a computer in the form of a power point presentation with an appropriate commentary. All the people in the home at this time have a computer and computer skills. Surveys received from the people who are already in the home indicate that they were satisfied with the admission process and procedure. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at Douglas House and Restormel House can be confident that their individual needs and choices will be met. EVIDENCE: Each person at both homes has in place a detailed plan of care. The documentation has been developed from a “history” of the person and the original pre admission assessment. Information has been included into the care plan on goals and aims to encourage independence and choice. Where restrictions have had to be made for safety information is included as to the reasons why. Guidelines are also in place where required for behaviour management. It is noted that the people in both of the homes have very complicated care needs. Advocate services are in place for those people in the home who have required this service. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 11 Prior to the inspection five surveys from the people in the home(s) were received. They indicated a satisfaction with the service they receive and include the following comments: “I can do what I want to during the day and night and week ends” “I like doing my charts and do them well”. The people in each of the homes are included in the day to day running of their home and are encouraged to voice their opinions informally and formally. Meetings are held regularly at the home and always include the people in the home. Everyone is encouraged to take part in the day to day running of the home and to include taking responsibility for individual cleaning duties and shopping for meals for example. Detailed risk assessments are in place for all activities externally and internally. Evidence is in place that the people in the home are involved in the care planning process Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people in the home can be confident that the routines of the home are arranged to suit them and individual activities are arranged which respect the choice and independence of each person. EVIDENCE: During the course of the inspection the people spoken to gave examples of where they were spending their day or had been. For example one person had just started a college course, one person was due to go to the cinema, one was going shopping. Individual daily records are completed well and evidence a person centred approach to daily life in the home. Each person has in place a weekly planner that has been drawn up by that person with support from the staff. The planners are very individual and Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 13 evidence that a wide range of interests and hobbies are followed. For example the planner of one person in the home indicates that they go to the cinema, swimming, art club and cook and prepare their own meals. Interaction between the people in the home and the staff was noted to be very positive with a friendly, respectful approach taken by the staff. There are clear rules in the home around smoking, alcohol and drugs. Mealtimes at the home are flexible and individual. Each person is encouraged to draw up a weekly menu and then take responsibility for that menu in the form of the shopping required. One person has recently required the support of the dietician and this service has been accessed and ongoing visits and support are in place at this time. Some meals are eaten outside of the home when the people are out on their visits to the city for example. All records of meals are in place as required by legislation in the daily handover sheets. Staff undertake duties and responsibilities for the house shopping. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at Douglas House and Restormel House can be confident that their personal and healthcare needs are met. EVIDENCE: The people at Restormel House and Douglas House are generally independent with personal care and require only prompting and encouragement from staff. More support is required from staff for the people in the home to develop social and independent living skills. Some of the people in the home have had complicated and difficult pasts resulting in admissions into care. Behaviours on occasions challenge the service and recently one person in the home had to leave due to behaviours that were affecting the well being and safety of the people in the home. This has been a difficult time for the people and the staff in the home and it is with credit to the management team that they handled this situation well. When behaviours do challenge the service physical restraints are avoided and staff use techniques such as distraction and a non-confrontational approach. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 15 Medication records were found to be accurate and completed appropriately. The people in the home are encouraged to take responsibility for their medication which includes collecting the prescription from the surgery and taking it to the pharmacy. Where appropriate the people in the home can take responsibility for their own medication administration and safe storage is provided to enable them to do this. A number of staff at the home(s) are undertaking accredited medication training. A sample inspection of this documentation indicated that the training is detailed and informative with support being provided by a college staff member. Each person at the home(s) is registered with a general practitioner and health care services such as dentistry are available locally. Where required support is available from specialists for example psychiatrist and behavioural advisors. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at Douglas House and Restormel House can be confident that any concerns or complaints are treated seriously and that they will be protected from abuse EVIDENCE: The home has a complaints policy and procedure in place that has been developed into an appropriate format for the people in the home to understand. This information is fully available on the notice board in the entrance of the home. In addition each person at the home has been issued with an individual copy of the complaints policy and procedure. The home have recently had to deal with an adult protection alert and procedures were followed correctly with satisfactory outcomes to the people in the home. The organisation provides in house adult protection training to all the staff in the home. All the staff except two of the new staff members have undertaken this training. The adult protection training for the new staff is booked to take place. Adult protection policies and procedures are in place to guide staff and protect the people in the home. In addition a locally issued “alerters” guide is in place for staff to refer to. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 17 Each person has their own bank account and accordingly manage their own finances with assistance from the staff as required. It is recommended that records of money being held on the premises for one person is recorded separately to the current records which are logged in the petty cash book. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Douglas House and Restormel House are living in pleasant, comfortable homes’ that are warm and clean. EVIDENCE: Restormel House has recently been closed with significant refurbishments having taken place during the closure period. The home now has two people living there and there are plans for more admissions. Bathrooms have been updated as has the kitchen and the communal areas and bedrooms. Douglas House was found to be homely, comfortable and clean on the day of the inspection. Some attention to general refurbishment is required in particular in the external courtyard of the home. Neither of the properties are suitable for anyone with limited mobility. The properties are Victorian with Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 19 steep stairs and steps leading up to the front door. There is a small courtyard area to the rear of both properties’, these areas are used for smoking. One of the properties at Douglas House has en suite facilities. The people in the home(s) are provided with a key so they can lock their bedrooms. The kitchen/dining area of Douglas House was found to be the “hub” of the home on the day of the inspection with the people in the home and the staff having good interactions about the plans for the day. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Restormel House and Douglas House have separate staff groups with a deputy manager based at Restormel House. A large number of returned survey forms (nine) were received from staff members. They indicated very positive comments from the staff about the standard of care that they are delivering and the job satisfaction that they receive. The following are some of the comments received: “The manager, deputy manager and other staff are always there to talk about anything”, “All staff including management give great support to service users in trying times”, “I think we support our service users to access the community really well”, “good training is provided”, “they do well at catering the service they provide to the needs of the individual service user”, “I believe Douglas House provides an excellent service”. During the day there is one to one staffing available for each person in the home. At night in each home there is one waking night staff member. When Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 21 the next admission takes place to Restormel House a sleeping in staff member will be employed. This staff member could if required in an emergency provide support to Douglas House. The manager is very clear that if the people in the home had care needs that indicated more night time support was required, this would be provided. The management team take it in turns to be on call to the home and consequently a manager is always available. The organisation has in place a training programme for each staff member and as such a large amount of in house training takes place. All staff have recently undertaken moving and handling training. New staff receive induction training that is based on the Skills for Care induction documentation. Evidence of this training was though not available on the day of the inspection. A random inspection of staff files took place to ensure that the correct recruitment procedures are being followed. References and criminal records bureau checks are held with the organisation and therefore could not be verified on the day of the inspection. A survey form from a relative received prior to the inspection stated: “When we visit the home the staff are always courteous and friendly”. Another stated: “The staff are always keen to help and offer all sorts of information to ensure we feel involved”. “The staff are welcoming, friendly and informative, they give fantastic care despite difficult behaviour”. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at Douglas House and Restormel House are living in well managed homes’ where their rights and choices are respected. EVIDENCE: The registered manager has responsibility for two homes. She is supported in her duties by two deputy managers. On the day of the inspection one of the deputy managers was on duty at Restormel House. The manager and deputy presented as capable and professional in their communications and interactions with the people in the home. Both the manager and her deputy have achieved the registered managers award qualification. Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 23 A representative from the organisation (quality assurance department) carries out the monthly visits to the home and provides (as required) a report of the Regulation 26 visit to the Commission for Social Care Inspection. Questionnaires have been devised for the people in the home, relatives and care managers to assess the quality of the care provided at the home. Routine health and safety checks take place and on the day of the inspection a health and safety representative from the organisation was carrying out a health and safety audit. Risk assessments are in place for all activities undertaken in the home and all areas of the home. Douglas House DS0000044469.V344090.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 x 2 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 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 3 x 3 x 3 x x 3 x Douglas House DS0000044469.V344090.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 YA23 Good Practice Recommendations To record in a separate record the money being held on the premises for one person. Douglas House DS0000044469.V344090.R01.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: 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 Douglas House DS0000044469.V344090.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!