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Inspection on 02/03/06 for Abberleigh House

Also see our care home review for Abberleigh House for more information

This inspection was carried out on 2nd March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff team works well together, and the habit of consulting residents is ingrained in everyday practice. The home is decorated to an exceptionally high standard.

What has improved since the last inspection?

A homely remedies policy has been drawn up and any medicines entered by hand on the medication administration sheet now have two signatures.

What the care home could do better:

It was recommended at the last inspection that a formal Quality Assurance system should be implemented to reflect the good practice of resident consultation. This was not checked today but will be discussed at the next inspection.The inspector commented in the last report that no evidence is held of proof of employee identity to ensure the necessary safeguards. (The regulations are not entirely clear about this and are currently under discussion). This will be raised at the next inspection. It was noted at the last inspection that some radiators do not have low temperature surfaces and these have not been risk assessed. This was not checked today, but will be carried forward to the next inspection.

CARE HOME ADULTS 18-65 Abberleigh House 17 Grove Park Road Weston Super Mare North Somerset BS23 2LW Lead Inspector Catherine Hill Unannounced Inspection 2nd March 2006 15:40 Abberleigh House DS0000008079.V285961.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 Abberleigh House DS0000008079.V285961.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. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Abberleigh House Address 17 Grove Park Road Weston Super Mare North Somerset BS23 2LW 01934 621397 01934 623162 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) Dr Joseph Conlon Mrs Jacquetta Miner Dr Joseph Conlon Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9) of places Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 9 persons aged 18 years and over with learning disabilities. May include persons aged 65 years and over 7th November 2005 Date of last inspection Brief Description of the Service: Abberleigh House is a large Victorian house providing residential care for young men and women with learning disabilities. The home is set in a quiet residential area with a large rear garden. Its sister home, Abberleigh Grove, is in the next road and residents from the two homes share many social events together and facilities. Most staff work in both homes as well as in the supported living service run by the homes’ owner. The home aims to support its residents to develop their independent living skills in a family environment with a view to moving on to more independent living if appropriate. Staff support residents to access community facilities and pursue their social, vocational and leisure interests. They also enable links with local health services. A range of other professional input is sought on each resident’s behalf and the team involves relatives appropriately to ensure that residents receive the services they need to enable them to enjoy the best possible quality of life. Respite care is offered, one client at a time. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the late afternoon and early evening of one day. The inspector spoke privately with four of the residents and spent time with the resident group in the lounge. She also spoke with the two staff on duty, and checked some of the records relating to residents personal care and to the management of medications. Residents evidently felt very comfortable and relaxed, and several people were able to confirm that staff consistently treat them with respect and kindness. Staff felt well supported by seniors and managers, and evidently get a great deal of job satisfaction. People felt listened to and that they are seen as individuals. Each of the residents has a full timetable of interesting and varied activities, and there are also lots of social activities arranged. People said that they enjoy their lives. What the service does well: What has improved since the last inspection? What they could do better: It was recommended at the last inspection that a formal Quality Assurance system should be implemented to reflect the good practice of resident consultation. This was not checked today but will be discussed at the next inspection. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 6 The inspector commented in the last report that no evidence is held of proof of employee identity to ensure the necessary safeguards. (The regulations are not entirely clear about this and are currently under discussion). This will be raised at the next inspection. It was noted at the last inspection that some radiators do not have low temperature surfaces and these have not been risk assessed. This was not checked today, but will be carried forward to the next inspection. 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. Abberleigh House DS0000008079.V285961.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 Abberleigh House DS0000008079.V285961.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): EVIDENCE: These standards were not assessed at this inspection. Abberleigh House DS0000008079.V285961.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): 6-10 Residents’ needs are well documented and they are supported to make their own decisions. Arrangements for promoting independence should be recorded in more detail. EVIDENCE: The staff team has been gradually expanding residents care plans, and there has been a noticeable improvement in the detail of these over the past year. However, many care plans could usefully be improved by including information on what each resident is being encouraged to do for themselves, and including detailed step-by-step plans for enabling residents to learn the tasks they want to that will increase their independence. Care plans are being formally reviewed every six months, but key workers also go through a comprehensive monthly checklist that covers personal care issues, health care, the persons environment, and any issues identified in the care plan. The daily records that staff are keeping on residents are now much more detailed, informative and regular than before. They provide a greatly improved record of events, progress, and interventions. Abberleigh House DS0000008079.V285961.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): 11-14, 16 Each person has plenty of opportunities to pursue their preferred lifestyle. EVIDENCE: Each person has their own full schedule of vocational, leisure and social activities. Most people attend day centres or college placements, and there are lots of group activities organised between the two homes. One person regularly goes to the gym with staff as this is part of his planned fitness programme. Some of the more able residents occasionally arrange their own activities. One person told the inspector about the holiday they were taken on this year. Holidays tend to be arranged in small groups. One person showed the inspector his file of achievements with certificates and photos showing him at work. Another resident was going out with a staff member the next day to shop for clothes and have lunch out. Residents go out for walks most evenings, to the local park or the local pub, and every Wednesday is Activity Night. The list of activities for the first few months of this year shows that people have had opportunities to join in Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 11 cookery groups at home, play indoor skittles, have arts and crafts sessions, have a beauty night (including hair colouring, face masks, nail painting, foot massages, and intensive care conditioners) with the alternative of a recent DVD for those who werent interested, go tenpin bowling with a visit to a restaurant afterwards, go to discos and karaoke, and see the Chinese State Circus. People felt that there is plenty to do and that their lives are rewarding. Residents are actively encouraged to maintain links with the other people who are significant to them. At present, people are being supported to buy cards and gifts for Mothers Day, and the residents files sampled included lists of the birthdays of those people they would like to send birthday cards to. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-20 Residents health care needs are generally well met but health action plans need to be developed to ensure that each person can access routine health checks. EVIDENCE: The care plans and associated records sampled showed that residents are supported to attend regular dental checks and opticians’ appointments, among other things, but there was no evidence available to show that the women had been offered smear tests, for example. Health Action Plans need to be developed, in line with the guidance of Valuing People. These need to show not only how each persons particular health needs are being met but also how they will be supported to access routine health check services. A homely remedies policy has been drawn up since the last inspection. It was recommended at the last inspection that any handwritten entries on medication records should be countersigned by a second member of staff. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 13 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 Peoples concerns are taken seriously and acted upon. EVIDENCE: The complaints procedure is very welcoming, and was updated in March last year to include the CSCIs new contact details. It includes clear instructions on how to phone CSCI. In practice, residents felt comfortable raising any worries or grumbles with the staff, and said that they feel people listen and try to put things right for them. Staff will also raise any concerns on residents behalf, and felt that the owners encourage this. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 14 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): 24-26, 28-30 Residents have a safe, comfortable and very pleasant environment that is well suited to their needs. EVIDENCE: There is a very high standard of décor throughout the home, and furniture and fittings are of a good quality. The environment is particularly comfortable and pleasant. There is a large lounge at the front of the building, and a dining room adjacent to the kitchen. There is also a small computer room that residents can use. Residents bedrooms have been decorated and furnished to suit their individual tastes. All bedrooms are single and two bedrooms are on the ground floor. Abberleigh House DS0000008079.V285961.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): EVIDENCE: These standards were not assessed at this inspection. Abberleigh House DS0000008079.V285961.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): EVIDENCE: These standards were not assessed at this inspection. Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 17 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 X 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 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X X X X X X X X Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 18 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. 2. 3. 4. 5. Refer to Standard YA9 YA19 YA34 YA35 YA39 Good Practice Recommendations Care plans should be expanded to give more detail on how individual residents independence is being promoted. Residents health action plans should be developed to help ensure that each person has regular access to routine health checks. To maintain proof of identity for all employees. The record of training to include the numerous one-to-one training sessions that the owner-manager provides. A formalised system of Quality Assurance that analyses the results of a resident survey, produces an action plan and feedback to residents and staff, should be developed Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Abberleigh House DS0000008079.V285961.R01.S.doc Version 5.1 Page 20 - 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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