CARE HOME ADULTS 18-65
Douglas House 8 Restormel Road Plymouth Devon PL4 6BJ Lead Inspector
Sheila Giblin Unannounced Inspection 3rd March 2006 11:00 Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 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.V269091.R01.S.doc Version 5.1 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.V269091.R01.S.doc Version 5.1 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.V269091.R01.S.doc Version 5.1 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 1st November 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 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.V269091.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on Friday 3rd March 2006 at both Restormel House and Douglas House. Tours of the premises took place and some records were inspected. Staff were spoken with in the course of their daily duties. Six service users who live at Restormel House were present during the inspection. Some of them do not have verbal communication therefore their opinions of the service are gauged by staff who know them well. Three service users who live at Douglas House were seen. One resident gave a good account of his lifestyle. Discussions took place with Kerry Libby, the registered manager, who accompanied the inspector in both houses during the inspection. What the service does well: What has improved since the last inspection?
Kerry Libby, the registered manager, is to be commended for her efforts and hard work since the previous inspection to improve the standards of the accommodation in Restormel House. The walls enclosing the patio area have been painted to brighten up the space with good effect. The lounge and two bedrooms have been painted. The hall and stairs are to be painted during the week following the inspection. Many carpets are to be replaced which with the recent redecoration, will make the home more attractive and homely. The kitchen in Restormel House has been planned for renewal by the end of March 2006. Following the last inspection the cooker was replaced immediately. Besides the physical appearance of the homes, progress has been made to update and improve the care processes, documents and record keeping in both houses. Person centred planning has been introduced. Staff have received
Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 6 training to understand the concept of this approach. Initially two residents’ care plans are being rewritten in the new style. The statement of purpose and service user guides have been reviewed to include the appropriate information and are now more accessible for residents with reading difficulties. An audiotape is a work in progress for the residents in Restormel who have sight impairment and profound learning disabilities. All residents have a statement of terms and conditions awaiting appropriate signatures of their representatives. The quality assurance and monitoring systems are in progress, with questionnaires being completed by residents with the help of staff. The responsible individual has conducted The Regulation 26 visits with reports being sent to the registered manager. Two lockable filing cabinets have been installed in Restormel in which to store residents’ records. The outstanding arrears of Disabled Living Allowance hve now been paid into the bank account of a resident in Restormel. The safe storage of substances hazardous to Health in Restormel has been improved with the use of a clearly printed poster instructing staff and by regular monitoring by the managers. 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.V269091.R01.S.doc Version 5.1 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.V269091.R01.S.doc Version 5.1 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, 5 EVIDENCE: Prospective residents at Douglas House have access to important information in the form of words and pictures to inform and assist them to make a choice. The Registered manager is producing an audio-tape to inform the residents in Restormel House about the services they receive. The statements of purpose now include the room dimensions and information concerning staff currently employed, including their qualifications. A statement of terms and conditions has been provided for each service user. There has been one new service users admitted to Douglas House 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. 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.V269091.R01.S.doc Version 5.1 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, 8, 10 Service users can be confident that their care needs will be met at Restormel House and Douglas House EVIDENCE: The person centred planning approach has been introduced in both homes. This will 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 interactions with service users of 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 are now kept in a locked cabinet in the office of Restormel House. Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 10 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): 11, 12, 13, 14, 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. They are involved in choosing menus, which are displayed. The kitchen is to be renewed and residents will then be able to use the facilities safely with staff to support and assist. In Douglas House the three 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. Residents enjoy going out to lunch to places of their choice as described by one resident when he came back from the city centre. Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 11 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 Service users can be confident that their personal and health care needs will be monitored and addressed. EVIDENCE: The changing and declining health care needs of the service users in Restormel House are monitored and reviewed. The service users are aged between 45 and 65. The registered manager informed the inspector that some residents have developed increasing levels of physical dependency. The layout of this converted Victorian town house makes it unsuitable for service users with physical disability or mobility problems. 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. Residents living in Douglas House are much younger and their care needs are very different. The 3 service users in residence at the time of the inspection were mainly independent in personal care other than receiving encouragement from staff. The service users have behaviours that challenge services. 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. Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 12 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 Residents can be confident that their concerns and complaints will be listened to and taken seriously. 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. The agency provides some in house training in adult protection, and the senior staff attended a multi-agency adult protection training course on 16th Feb 2006. 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. All service users’ arrears have now been reimbursed with evidence seen in their bank accounts. Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 13 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, 25, 26, 27, 28, 30 Service users in Douglas House live in accommodation that is comfortable and safe. Service users in Restormel House live in accommodation that is being upgraded and modernised to provide a homely and comfortable place in which to live EVIDENCE: Douglas House was clean, comfortable, and appropriately furnished. It provides an environment of a good standard. Service users’ 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. Bathrooms are to be upgraded and a shower installed when funding becomes available. Restormel House is undergoing a complete ‘make-over’. The lounge has been redecorated and was awaiting the fitting of a new carpet. Some service users’ bed rooms have been redecorated with others to be done in an ongoing programme of renewal and refurbishment in a timely fashion that is acceptable to residents and as funds become available. The kitchen is in the process of being replaced. The cooker has been replaced in the interim. The paint on the kitchen ceiling was flaking. Both homes have limited outside space. The patio area in Douglas house was attractive and satisfactorily maintained. The patio area in Restormel House has
Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 14 been improved with the painting of the surrounding walls. Residents made good use of the space on the day of this inspection sitting in the sun with a cup of tea and enjoying a cigarette. Both houses were clean and free from unpleasant odours. Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 15 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): 31, 32, 33, 35 Sufficient skilled staff are employed to meet the high level of needs of the service users EVIDENCE: The registered manager of Douglas House now also manages Restormel. The two establishments have separate staff groups. Staff are still adjusting to the new structure. Staff spoken with were positive about their work. Douglas House staff had found a recent team-building event beneficial. This has been a time of transition for Restormel House with the changes in the management structure and the introduction of a different philosophy of care. 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.V269091.R01.S.doc Version 5.1 Page 16 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, 38, 39, 42 Service users in both Douglas House and Restormel live in an environment where 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, enthusiastic management style. She is introducing 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 quality assurance system is being introduced by the newly set up Quality Assurance Department in the Regard Partnership. Mark Warwick is the new Quality Assurance Manager and has responsibility for undertaking the Regulation 26 visits. He last visited on 18th January 2006 and had reported this visit in writing to the manager. Questionnaires have been done for residents, relatives, care managers in appropriate formats to assist everyone to access the questions and enable them to give their views about the quality of the services being provided. Routine health and safety issues are managed satisfactorily and records are maintained up to date and accurate. Fire and accident records were in order.
Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 17 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. Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 18 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 3 2 X 3 X 4 X 5 3 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 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 4 3 3 X X 3 X Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 19 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. Refer to Standard Good Practice Recommendations Douglas House DS0000044469.V269091.R01.S.doc Version 5.1 Page 20 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
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