Inspection on 04/10/07 for Abbotts Barton

This inspection was carried out on 4th October 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

Abbotts Barton 04/04/07

Abbotts Barton 17/10/06

Abbotts Barton 20/09/05

Abbotts Barton 21/06/05

Abbotts Barton 07/12/04

Abbotts Barton 18/02/04

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Thorndene

Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

Dovedale Court

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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 Abbotts Barton 3 Abbey Gardens Chertsey Surrey KT16 8RQ Lead Inspector Lesley Garrett Unannounced Inspection 4th & 19th October 2007 11:15 Abbotts Barton DS0000013482.V345728.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 Abbotts Barton DS0000013482.V345728.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. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbotts Barton Address 3 Abbey Gardens Chertsey Surrey KT16 8RQ 01932 569455 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) Welmede Housing Association Ltd Mrs Kathleen Murphy Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th April 2007 Brief Description of the Service: Abbotts Barton is a detached house, providing accommodation and care to six people with learning disabilities. The home has six single bedrooms, five on the first floor, and one on the ground floor, which has an en-suite facility. Welmede Housing Association manages the home and has a contractual arrangement with Surrey and Borders Partnership NHS Trust to provide staff. The home is situated in a quiet residential road in Chertsey, a short distance from the town centre, which has a range of shops, a supermarket, church and several pubs/restaurants. The weekly fees for the home are £1,700 on average per week. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ and took place over two days. The inspector arrived at the service at 1115 and was in the service for two and a quarter hours. Only two people who use the service were at home that morning and sooon after the inspection commenced they went out for the afternoon. The manager explained that the staff all had to attend a meeting and arrangements had been in place for all of the residents to attend the local day centre. A second vist was made to the service on 19th October 2007 to allow the inspector to meet the staff and the people who use the service and this took place over two hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. We asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their hospitality during this visit. What the service does well: The documentation, which includes the individual care plans, health plans and risk assessments, were of a good standard and regularly reviewed by the staff with evidence of involvement by the people who use the service. Each individual had an activity plan in their folder and were encouraged and supported by the staff to make decisions about their daily lives. Meetings were held with the people who use the service and their comments and decisions documented. The staff rotas demonstrated that the manager ensures a good mix of staff on duty for each shift. During their supervision session’s staff are encouraged to select regular training sessions that the trust provides for them. These sessions are in addition to the mandatory training that all staff attends. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 6 From the evidence seen by the inspector and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. 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. Abbotts Barton DS0000013482.V345728.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 Abbotts Barton DS0000013482.V345728.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. The arrangements in place for assessing needs are good ensuring prospective individuals needs and aspirations are assessed before admission to the home. EVIDENCE: The manager informed the Inspector that current residents have been with the company for a long period of time, and pre- admission assessments had been archived. Two policies were observed called ‘the moving in policy’ and a ‘moving on’ policy. The manager stated that these policies were the ones followed for any new admissions and if one of the residents had to move to another service. The policies describe the procedures to be followed for admission or discharge from the home and they include obtaining an assessment of needs and introduction visits to the home, including overnight and weekend visits. This provides prospective individuals the opportunity to meet the staff, other people who use the service and view the bedroom they will live in. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 67&9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed good care plans and risk assessments. The documents were current and well recorded to ensure that the people who use the service have their health needs met. EVIDENCE: We sampled two individual plans of care, which the manager and staff had developed with evidence of involvement from the people using the service. We observed that dates for reviews were in place therefore ensuring the changing needs of the individuals were being met. The plans included information about likes and dislikes and the support each individual needs with personal care. A survey form retuned to us stated that since their relative has been at the home they are much happier and able to do more for themselves. The staff said the people who use the service are able to get up and wash and dress themselves with minimum assistance. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 10 We observed that some of the care plans had been adapted for people with reading difficulties and the manager showed examples of how these plans could be adapted to suit the individual. On the day of the inspection the manager demonstrated that people who use the service made all the decisions about the running of the home from the decorating and choosing of furniture to their meals and holidays. It was very clear from this inspection that people currently living at the home were enabled to make such decisions with the support from the staff. During the second visit to the home the residents were asking the staff to take them to the shops. Friday afternoons are spent with activities they wish to participate in. The staff said that they would either go shopping or go out for coffee it was very much their choice. One resident was keen to tell the story of his visit to see the horses at Sandown. The care plans examined demonstrated that staff enabled people who use the service to take responsible risks and this was well documented and signed by the people who use the service and staff. The plans observed included going on holiday, using the home’s vehicle and smoking for one individual. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 11 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes and maintains service users involvement in their community, offers appropriate activities and maintains friendships. Service users are encouraged to be involved in the running of the home and improving daily living skills. The available choice of food provided was of a good standard. EVIDENCE: In each individual folder for the people who use the service we observed their activity programme. The manager stated that five individuals attended a day centre and one an art group. No individual currently at the service had paid or supported employment. The manager reported that the home had very good neighbours who often chat to the individuals when they were in the garden and the neighbours would come in for tea. Some of the people using the service were able to visit the local shops unaccompanied and others with support. The manager told us that Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 12 trips to the local pub and restaurants were also enjoyed. Holidays are taken but this is usually in small groups. One individual told us about his recent holiday which he said he had enjoyed and had been to the seaside. Staff said that they supported another resident to visit a family member in Wales travelling on the train for the day. Family and friends were encouraged to visit and can play an active part in the lives of the individuals. There is no restriction on the visiting times and the managers stated they were always welcome. The manger told us that every Thursday evening staff sit with the residents to select the meals for the week. We observed the kitchen facilities and the manager stated that it had recently been refurbished and was only completed the week prior to the site visit. A picture board was in place in the kitchen, which showed the food that would be eaten that day. The residents are encouraged to help to prepare meals with the assistance of the staff. On the day of the second visit the residents sitting in the garden were discussing the meal for that evening one individual stated that he wanted spaghetti bolognaise but was reminded that they had eaten that the night before. The staff stated that healthy food is encouraged and fresh fruit and vegetables are always available. We observed that the people who use the service are weighed every two weeks and any concerns about their nutrition and they are referred to the general practitioner (G.P.). Any special diets are well documented in their individual folders. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 13 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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has documentation to evidence that service users receive personal care and attend health care appointments to ensure their wellbeing and welfare. The homes medication procedures are robust to ensure the safety and wellbeing of service users. EVIDENCE: Two care plans were sampled and they included clear records to demonstrate that the residents receive personal care in the way they prefer and guidelines were in place for their early morning routines. The manager stated, and we observed in the care plans, that each individual only needed very basic support and this is clearly documented. The times for getting up, going to bed and for baths and meals are very flexible the manager stated and this was also observed in the individual plans. On the day of the second visit some residents were in the garden one was sitting in the lounge and another was having a rest on his bed. The staff team stated this is a normal routine for all of them on a Friday afternoon as no activities are arranged, as this is the day that individuals can choose an activity. Two individuals have a one to one activity Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 14 with their keyworker on this day and this is evidenced on the main house activity plan. All the people who use the service are registered with a local G.P. and can visit the surgery when they request it and are accompanied by a member of staff if they want this. The chiropodist visits the home every six to eight weeks and reflexology is also available for three individuals. Appointments and visits are also arranged when needed for the opticians and dentist. The residents also have access to a psychiatrist when needed and can also attend hospital appointments with the support of the staff. The manager stated that no individual self medicates and the home uses a local pharmacy that uses the monitored dose system. We sampled some medication administration charts and found that there were no gaps and were all completed satisfactorily. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 15 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure to demonstrate that complaints will be acted upon and a Safeguarding Adults policy and procedure to ensure that service users are adequately protected. EVIDENCE: The home has a complaints procedure that includes time scales for responding to complaints. There is an appropriate complaints leaflet for residents that include pictures and symbols, and copies of these are kept in the individual care plan folder and the Service Users’ Guide. The manager explained that no complaints have been received by the home since the last site visit and no complainant has contacted the Commission with information concerning a complaint either. The manager and staff confirmed that any issues that are raised by the residents are dealt with at the time. The manager showed us their safeguarding adults procedures and this was in line with the local authorities policies. The manager stated that all of the people who use the service are aware of how people should behave appropriately. Procedures are available for them to discuss with their keyworker and are also available in their individual care plans. The manager stated that the subject of appropriate behaviour is discussed during resident meetings so that staff can be confident that the residents have an understanding. The home has had no referrals under these procedures and all staff has now received training. On the second visit to the home the staff were Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 16 knowledgeable about the local authorities procedures and how to report an allegation and also confirmed that they had received training. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a safe well maintained home which is comfortable, homely, clean and hygienic. EVIDENCE: Following the last inspection in April 2007 requirements were made concerning the environment. The manager stated that they had recently moved to the house and a lot of work was required to ensure that the people who use the service had a good environment to live in. The refurbishment programme has now been completed with just a few finishing touches to complete. All communal areas have been decorated and all bedrooms. The people who live there chose all the paint colours and the furniture. The kitchen has been recently finished and a new bathroom has been installed upstairs and in the en-suite. There is one en-suite bedroom downstairs and this has also been decorated. One survey returned to us said ‘he has a lovely room with his own personal possessions around him’. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 18 The gardens are safe and accessible and one individual was sitting out on the day of the inspection enjoying the sunshine. During the second visit all the residents sat in the garden at one time talking to the inspector and staff. At the end of the garden the people who use the service have elected to have a quiet area with some chairs to enjoy some peace and quiet and an area to sit if they are feeling anxious and need time on their own. The staff told us that barbeques are often enjoyed by the individuals, which are taken on the patio area. The home has a laundry room that was observed to be clean and tidy. All people who use the service are supported by the staff to do their own laundry and a rota is in place to do this. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and qualified staff team supports the people who use the service, who haven also undergone training. Recruitment practices at the home protect individuals in the service. EVIDENCE: The manager stated that the home has fourteen members of staff but only five of them have their National Vocational Qualification (NVQ) at either level 2 or 3. The manger stated that the home has had some problems with the local NVQ centre, which has resulted in this training being suspended. It will be a recommendation at the end of the report that the home resumes the training for the staff to ensure that all members of staff are suitably qualified. The home has an induction package for new staff and this is linked the skills for care, which is a national training organisation. We observed one recruitment folder for a member of staff. The manager stated that most staff had transferred from the local hospital when it closed and had been employed for a number of years. The folder we observed the member of staff had been employed since 1985. The manager stated that she Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 20 is waiting for the folders to be transferred from the hospital. The manager said that when the transfer to Welmede is complete and the trust is no longer responsible for recruitment all folders would be held at the home. The deputy stated at the second visit that the trust ‘s practice was to do all the recruitment then to send the staff to the homes that required new employees. The manager at the home did not have the opportunity to see the member of staff prior to them being employed. This practice will now stop and the manager will be responsible for recruitment locally. The manager confirmed that all members of staff have criminal record bureau checks prior to starting their employment and these were observed. The manager stated that the trust supplies the home with a list of training dates and that staff select the training they would like to do when they attend their supervision sessions. Mandatory training takes place and this includes manual handling, fire, basic life support and vulnerable adults. Evidence of this training was seen in the individual folders of staff. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and service users can be confident that their views are listened to. The health and safety of service users are protected. EVIDENCE: The manager was the home’s deputy manager prior to taking this post and has many years of experience working with younger adults. She has a nursing qualification and has also completed her registered managers award. The manager stated that she has recently sent out quality audit forms to the families, friends and other visiting professionals to the home but has had very little response. Meetings are held every six weeks with the people who use the service and the decisions made at these meetings are documented. The Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 22 manager stated that they are the residents meetings and can request further meetings if they would like to. Health and safety checks had taken place and the dates of these checks were documented in the AQAA that had been returned to CSCI. The home has current gas and electrical certificates and the testing of all portable appliances was up to date. Fire equipment had recently been checked and the dates of these checks were visible on the appliances. The manager stated that the trust recommends fire training takes place every three years but it is recommended that the home clarify this with the local fire authority on the recommended timescales for this training. Accident reports are in place for each resident. They are kept in a folder and this was observed. The accident reports matched the Regulation 37 notices that CSCI had received. Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X X 3 Abbotts Barton DS0000013482.V345728.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 Refer to Standard YA32 YA42 Good Practice Recommendations It is recommended that the home restart its programme of NVQ training for those staff without this qualification. It is recommended that the home consults with the fire officer for clarification on how often fire training should take place within the home. 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