Inspection on 02/11/05 for 91 Redlands Lane

This inspection was carried out on 2nd November 2005.

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

91 Redlands Lane 06/10/08

91 Redlands Lane 06/10/06

91 Redlands Lane 23/06/05

91 Redlands Lane 14/12/04

91 Redlands Lane 08/07/04

91 Redlands Lane 06/01/04

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

CARE HOME ADULTS 18-65 91 Redlands Lane Fareham Hants PO14 1HG Lead Inspector Gina Pickering Unannounced Inspection 2nd November 2005 10:00 91 Redlands Lane DS0000012365.V260277.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 91 Redlands Lane DS0000012365.V260277.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. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 91 Redlands Lane Address Fareham Hants PO14 1HG 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) 01329 829661 Community Integrated Care Ms Linda Roxburgh Care Home 3 Category(ies) of Learning disability (2) registration, with number of places 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users betweem the ages of 19-60 years of age may be admitted. 23rd June 2005 Date of last inspection Brief Description of the Service: 91 Redlands Lane is a care home that offers care for two people who have a learning disability. The property is owned by Knightstone Housing Association and is managed by Community Integrated Care who is the registered provider. The home is situated in a residential area near to the to the centre of Fareham. There is easy access to local recreational and health care facilities. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three hours on 2nd November 2005. The inspector spoke with one of the two gentlemen living at the home, the manager and two staff members and assessed a sample of documentation. The manager informed the inspector that the service users living at the home like to be known as gentlemen, this was confirmed with one of the gentlemen and shall be reflected throughout the report. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 6 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 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 7 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 Explanations will given by staff at the home in a manner that prospective service users understand will enable them to make informed choices about the suitability of the home for them. A procedure for the assessment of prospective service users is in place and will be implemented to ensure that prospective service users can be met at the home. Service users and their representatives are made aware of their rights and obligations of residency at the home with revised statements of terms and conditions of residency and explanations in a manner that they can understand. EVIDENCE: A service users guide and statement of purpose describing the service the home provides is available in a written format. Due the nature of the abilities of the gentlemen living at the home any written, pictorial or audio version of this information is not appropriate. The manager and staff member said that they discuss verbally information out then home to the gentlemen in a manner that they can understand. The manger acknowledges that if there is a change in the service user groups the format of theses documents would need to be revised. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 8 No new service users have been admitted to the home for eight years. Policies and procedures are in place to be initiated when a vacancy arises at the home. The manager discussed with the inspector the importance of this pre admission assessment process to ensure that prospective service users needs will be able to be met by the staff group at the home, the mix of service users will not generate problems for either service user and that the general environment will be suitable for the prospective service user. Revised terms and conditions have been provided for each gentlemen that have been signed by an appointed CIC representative of the gentlemen. A breakdown of the fees is included within the terms and conditions. 91 Redlands Lane DS0000012365.V260277.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): These standards were not assessed at this inspection. EVIDENCE: 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 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): 15 & 17 The gentlemen are supported to maintain links with their families. The gentlemen are supported to choose a healthy varied diet. EVIDENCE: Meals are planned on daily basis with input from the gentlemen. A record is recorded on each gentlemen’s daily evaluation evidencing they each receive a varied nutritious diet. The management of the home encourages the gentlemen to retain contact with family and friends. Care plans document the support and assistance that each gentleman requires to sustain these relationships. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 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): 20 The health and welfare of the gentlemen living at the home is protected by good medication administration practices. EVIDENCE: Policies and procedures are in place about the storage and administration of medications. Gentlemen’s medications are stored in a locked cabinet in their own flat. Medication administration sheets are completed accurately, documenting medications administered and the reason for any medications that have not been administered. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 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 The gentlemen at the home are able to express concerns to staff members and know that these concerns will be acted upon. EVIDENCE: A complaints policy is located in each gentleman’s documents. The manager discussed with the inspector that it is discussed with each gentleman that they are able to voice concerns to any member of staff. Due to the limited verbal communication of each gentleman, staff members have to interpret verbal and nonverbal actions to assess whether a concern or a complaint is being expressed. One gent clearly voiced to the inspector his dissatisfaction with the condition of his kitchen during the course of the inspection. The manager was unaware as to whether relatives had a copy of the complaints procedure, it was agreed that a complaints procedure would be given to relatives. One complaint had been received since the previous inspection that was located in one of the gentleman’s documents. The manager described the action she had taken to resolve the complaint. It was advised that a copy of the complaint and the action taken to resolve the complaint is placed in the complaints record book. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection. EVIDENCE: 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 14 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 The gentlemen at the home are protected by robust recruitment procedures. The staffing structure and well trained and competent staff assure the gentlemen’s well being and safety. EVIDENCE: Recruitment polices and procedures are in place. Inspecting staff file files evidenced that these procedures followed including the obtaining of two written references and CRB and POVA clearance on each new employee. Increased challenging behaviour of one of the service users had suggested that reliance on agency staff due to staff vacancies had adversely affected the ability of his social and emotional needs be met. Involvement of the multidisciplinary team has resulted in changes to the staffing structure of the home. This and the successful recruitment of new staff members have already seen a reduction in the challenging behaviour of this gentleman. This evidences that the home adapts staffing structures to meet the changing needs of the gentlemen at the home. All staff members receive annual mandatory training that includes fire safety, moving and handling, and administration of medications that is coordinated by the training officer for CIC. The manager identifies specific training required to equip staff with the skills to care for and support the gentlemen. Such training is then accessed through CIC’s training officer. One staff member told the 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 15 inspector that she receives training to equip her with the skills to meet the needs of the gentlemen at the home. New staff members are progressing through an induction programme that incorporates the social skills for care guidelines. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 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): 37,39 &42 The gentlemen’s well being is enhanced by the presence of a competent manager. The gentlemen’s opinions and wishes are an integral part of the running of the home. Delays in the refurbishment of the downstairs kitchen continue to potentially compromise the effectiveness of the good practice within the home of protecting the health and safety of the service users. EVIDENCE: The registered manager has been in post for two years. She discussed that her management skills have developed whilst undertaking the registered managers award. The manager informed the inspector that supervision form her line manager supports her to fulfil her role managing 91 Redlands Lane. But it was noted by the inspector and discussed with the manager that there are no hours allocated to her to undertake managerial paperwork. She 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 17 discussed that there are sometimes difficulties completing paperwork, as she is rostered to provide support and care to one of the gentlemen when working. Service users views about the service provided by the home are obtained by one to one conversations with them and monitoring their responses to activities and events happening in the home. The change in staffing structure has arisen because one of the gentlemen was expressing his displeasure of the previous staffing situation by exhibiting increased challenging behaviour. This evidences that the management of the home responds to views expressed by the gentlemen. Further views about the management of the home and the service they are providing are gathered form the gentlemen and representatives of the gentlemen during their annual multidisciplinary reviews. Requirements were made at the previous inspection about refurbishing the downstairs kitchen to meet the needs of the gentleman living there and ensure the health and safety of that gentleman. The manager told the inspector that she has been informed by Knightstone Housing Association that the kitchen will be refurbished in November 2005. The manager is still waiting for Knightstone Housing Association to act about reducing the distribution temperature of the hot water from the taps. Risk assessments and action to be taken have been put in place by CIC to reduce the risk this poses to the gentlemen in the meantime. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 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 91 Redlands Lane Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000012365.V260277.R01.S.doc Version 5.0 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. 1 Refer to Standard YA37 Good Practice Recommendations Management hours should be included within the managers working hours to allow her to fulfil her role. 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 91 Redlands Lane DS0000012365.V260277.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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