CARE HOME ADULTS 18-65
Amber House 33 Shorncliffe Road Folkestone Kent CT20 2NQ Lead Inspector
Lois Tozer Announced 5 September 2005 9:30 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 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 Stationary 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. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Amber House Address 33 Shorncliffe Road, Folkestone, Kent, CT20 2NQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 254459 Maryanne Swaffer Care home only 2 Category(ies) of Learning Disabilities x 2 registration, with number of places Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26/04/05 Brief Description of the Service: Amber House was first registered on 26th July 2004 to provide accommodation and personal care for a maximum of 2 service users between the ages of 18 to 65 who have learning disabilities. The building is suitable to those who are physically mobile within the home envirnonment. Situated on the Shorncliffe Road area of Folkestone, it is ideally placed for access to public transport, with rail and bus stations being approximately 10 minutes walk away. The local Adult Education Centre and South Kent College are a very short distance and the main shopping centre of Folkestone is around 15 minutes walk. Pleasant gardens and walks overlooking the sea are within easy reach. Accommodation is provided on the ground and first floor. There are two communal toilets, one communal bathroom and one, currently unregistered, bedroom has a full en-suite with shower facility. Communal space comprises of a large lounge / diner and domestic kitchen. There is an office space with laundry facilities to the side of the premises. A reasonably sized, secure rear garden with patio is accessible for all service users. The home has access to a 7 seater vehicle. The registered manager currently lives within the premises and aims to eventually register the en-suite bedroom and move out. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory announced inspection took place between 09.30am – 3.15pm. Both people living at the home were happy to give comments about their life at the home; their comments and perceptions are included throughout the report where possible. Both either said or indicated that they were well supported in the home and had a wide range of interesting activities to do each week. One individual is uncertain if they wish to remain at Amber House, although they could not express any specific dissatisfaction and also expressed a great deal of enjoyment with the lifestyle they were able to lead since moving in. A care management review is planned, the individual expressing a wish to converse with the care manager about their future. Paperwork seen included individual support plans, risk assessments; medication and administration documents; daily activity records, training details, duty rota, pre-inspection questionnaire and menu. The house is a pleasant, well-presented detached property surrounded by its own gardens. Work is planned to build a conservatory to the rear of the lounge, opening onto the garden, but no firm date has been set. There are plans to register a third bedroom in the near future and a fourth at some future point. There is a high level of activities available to residents and the range of choice for activities outside of the home is extensive and well supported. Comments expressing the suitability of the home’s services were made clear by both residents as follows; ‘Is nice here, [pointing at owners and smiling] friends’. ‘Yes, I have visitors regularly, and go to my clubs each week. I really like [key worker], we go to town together most days. I enjoy what I do, and I feel safe here, but I want to move on’. What the service does well:
Each person has a large part in the day-to-day running and a big say in what goes on. All decisions taken are in consultation with the residents, and in the main, are led by their aspirations. A support package to enable a younger adult to make a supported transition from school to a more adult environment is in place and has been well received. Each person, on a daily basis chooses meals, and both have a great deal of involvement in the preparation of food. Foodstuff is fresh and of good quality, both persons are encouraged to shop for the household items when out and about. Lots of trips into the local community take place each week, one resident said that shopping and choosing was their favourite activity and described the long
Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 Page 6 process of decision making when purchasing something for their room, saying how staff had supported them well. Trips out as a group are enjoyed and a range of local pubs, places of interest and restaurants are regular features. 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. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 standard(s) 2, 3 Individual needs are thoroughly assessed to ensure that the home can meet individual needs and aspirations. The home is meeting current individuals needs, but one person feels that the home is not suited to them. EVIDENCE: The manager has a robust and thorough assessment tool that highlights the individual needs. Previous assessments conducted by the home have highlighted a person placed, by care management, as unsuitable due to environmental issues. In highly unusual circumstances, the individual moved in, and the providers responded by adapting the environment to meet their needs. The placement is under review, and the individual, while enjoying many aspects of the home, states they feel that they ‘should move on now’. A care management review is planned and this must be discussed in depth. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 standard(s) 6 The individual plan does reflect the service users strengths and needs in a clear manner; however, the document is so full of information the good work is in danger of being lost. EVIDENCE: The plan has really improved and a basic strengths and needs summary details what level of support each person needs each day. A big collection of relevant information is contained in the plan, from pre-admissions assessments, past history, medical information, handling assessments, risk assessments etc, but is not clearly indexed or put together in a user friendly way. Much information is repeated. Because, at this moment, the staff team consists of only 2 paid employees, who work alongside the providers, both people benefit from high levels of continuity. Plans to increase the registered numbers (to a maximum of 4 eventually), will lead to a larger staff team, and clear documentation will be paramount in ensuring the very high care standards are maintained. A recommendation that this take place has been made. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 standard(s) 11, 12, 13, 14, 15, 16, 17 Residents are supported to develop their skills in communication and independence. Age and culturally appropriate activities are offered, accepted, and enjoyed. Support to access the local community is good. There are lots of leisure opportunities that have been chosen by residents. Personal relationships are supported with advocacy assistance as required. Residents are encouraged to take an active role in acknowledging their responsibilities. The ranges of foodstuffs offer residents a healthy diet. EVIDENCE: Support was provided to residents in a positive manner that stretched communication skills and encouraged greater independence. Co-operation, sharing and mutual respect are very much encouraged. An age appropriate placement has been secured to enable a younger resident’s transition into the adult world in a similar surrounding by way of private day centre. Older persons clubs and organisations that are of interest to the other individual are accessed frequently. The individual said they liked it a lot, but still referred to it as ‘school’. To support this adult development, it would be appropriate to gently reinforce the difference with a more appropriate name, such as college. This should be noted in the communication plan. Advocacy has been
Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 Page 11 successful in determining the long-term wishes of an individual. Both residents said that they liked to do the cooking and took it in turns. Records of food eaten showed a varied and nutritious diet, and the main meal seen was freshly cooked, nutritious and was being enjoyed by all. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 standard(s) 19, 20 Healthcare is well supported, but outcomes can be difficult to find due to the way they are currently being recorded. Per risk assessment, staff take full charge of the medication, which is well managed. A full medication review is recommended for one individual. EVIDENCE: All contact with healthcare professionals is documented and is followed up, but the place it is recorded can vary and therefore be hard to trace. A recommendation to streamline this has been made. The action taken by the home to seek advice is speedy and meets individual needs. Work with the CLDT is taking place to reduce anxieties for an individual. Medication is well managed and is very well documented. All staff who administer medication have had basic training, which, at present, meets the service needs. One individual has received a psychiatrist review, but stated that they felt giddy a lot of the time. A full GP medication review is strongly recommended. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 standard(s) 23 Residents say they feel safe and that they trust staff. Adult protection training updates are required for all employees. EVIDENCE: The home has abuse policies and procedures, as well as the local authority Adult Protection protocols. Both people living at the home said that they feel safe and trust the staff. One staff member has up-to-date adult protection training, but the remaining 3 principal carers have not, which is required. Additionally, training in mental health awareness is required. Any money held on behalf of individuals is well documented and accountable. Restrictions to individual access to personal allowance have been passed to care management to assess. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The home is comfortable, homely and safe, providing bedrooms that are suitable for each individual. Residents have chosen their own furniture and had input in decoration. Toilets and bathing facilities are suitable, with a bath hoist being considered. There is one communal room and a large garden with patio. Adaptations to enable access to the first floor are in place. The home is clean, hygienic, and homely. EVIDENCE: Both residents like their rooms and the house. They enjoy the freedom of access to every part and the high level of involvement offered. Plans to fit over-riding locks on bedroom doors are in place, and bathroom doors are now fitted with suitable locks. The bathroom has been improved and enlarged, and an occupational therapist assessment is recommended before the purchase of adaptations, such as a bath hoist. At present, using the moulded seat facility within the bath enables bathing to take place. There is a very homely, family, atmosphere, with residents encouraged to express what they want in their shared home. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 The recruitment process had been updated and is now robust. Training would benefit from enhancement, especially service user condition focused provision. EVIDENCE: Outstanding information for staff employed was advised to now be in place, and the manager understands the recruitment procedure required by the Care Homes Regulations 2001, and advised will follow them in all future employment issues. Health and safety training is being pursued to fill the gaps (caused by courses being cancelled), but little service user needs focused training has been obtained. A requirement to provide adult protection and mental health awareness training has been made. The manager should look to herself and the team accessing a wider range of learning disability and mobility specific training in the next 12 months to increase the knowledge base before increasing the service user numbers. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42 The home has a focused ethos on consultation and supporting service users views, wishes and aspirations. Although no formal quality assurance programme is in place at this time, quality is being well maintained. Health and safety is well considered and documented, protecting all persons living, or working, in the home. EVIDENCE: Weekly meetings on a Friday night are the most formal type of regular consultation, and the outcomes are documented and followed up. Each day, each person is consulted as how they will manage their day. Individuals have significant input with decision making in the home, and joint activities only take place with prior agreement. All relevant documentation pertaining to health and safety is now in place. Regular checks take place to ensure safety, all of which are documented. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23
ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 2 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Amber House Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 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. 1. 2. Standard YA23 & YA35 YA26 Regulation 13 (6), 18 (1, c[i]) 12 (4,a) Requirement Adult Protection and mental health awareness training for all staff. Fit locks that can be over-ridden to service user bedroom doors that they are able to operate. Timescale for action 31/03/06 01/03/06 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 YA2, YA19 YA6, YA19 Good Practice Recommendations Review named persons placement with care management. Seek a full medication review from the individuals GP. Streamline all the documentation in the individual plan, indexing where needed, to make more user friendly. Make clear note on individuals own vocabulary and meaning of certain words. Amber House H56-H05 S59808 Amber House V236177 050905 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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