Inspection on 13/03/06 for Appleton House

This inspection was carried out on 13th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Appleton House 07/06/06

Appleton House 05/05/05

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME ADULTS 18-65 26 Chafen Road Bitterne Park Bitterne Manor Southampton Hampshire SO18 1BB Lead Inspector Chris Johnson Unannounced Inspection 13th March 2006 10:30 26 Chafen Road DS0000061570.V252104.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 26 Chafen Road DS0000061570.V252104.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. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 26 Chafen Road Address Bitterne Park Bitterne Manor Southampton Hampshire SO18 1BB 02380 286290 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) Truecare Group Limited Miss Ceridwen Ann Wood Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Mental Disorder, excluding learning disability or dementia One service user aged 17 may be accommodated from 29th July 2005 until 14th September 2005. 5th May 2005 Date of last inspection Brief Description of the Service: 26 Chafen Road also known as Appleton House is situated in the Bitterne area of Southampton. The home is registered for seven service users with mental health needs. The large detached home consists of seven individual flats, which contain en-suite facilities and basic kitchen areas. The home also provides a separate service user kitchen and communal lounge and dining area. To the front of the property is a small garden and to the rear is a large landscaped garden. The home is situated close to local shops and amenities and a short car or bus journey away from Southampton city centre. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection carried out for the year April 2005/06. This inspection was unannounced and took place on the 13th March 2006. The purpose of this visit was to carry out an inspection of the home and follow up on requirements made at the last inspection. Both reports should be read for an overview of how the home is meeting the standards. Evidence for this report was gained from a number of sources. These included: Discussions with residents and staff, observation of care practices, a tour of the premises that included looking at service user’s bedrooms and all communal areas of the home and inspection of records. The acting manager was not available during this inspection. Written and verbal feedback was however provided to the acting manager on the 16th March 2006. Two immediate requirements were made as a result of this inspection. What the service does well: What has improved since the last inspection? All requirements from the previous inspection have been met. This has ensured that residents are provided with better information and are more aware of their rights’. The garden pond has now been made safe and improvements have been made to the physical environment, with further improvements planned making the home a more comfortable place to live. Management support has improved, as has the staffing structure. This has provided staff with better support and supervision and staff morale has improved. Records including, care plans and risk assessments have been reviewed and updated to provide better detail and information. Residents have all been provided with keys to their rooms. Staff records have been improved and show that staff are fully vetted and checked before being allowed to work within the home. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 6 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. 26 Chafen Road DS0000061570.V252104.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 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 The home provides prospective residents with sufficient information to enable them to decide whether the home is right for their needs. The admission and assessment procedure ensures that only people whose needs can be met move in. The home cannot however demonstrate that they can fully meet all residents’ needs. EVIDENCE: All residents have now been issued with or offered a copy of the Service User Guide to the home and contracts have been amended and issued to residents. All additional information as required at the last inspection has now been included. This ensures that residents are made more aware of their rights’ and offers them greater protection and assurance. Some residents prefer not to hold copies of these documents and this is accepted and is their right. It was agreed with the acting manager that in these instances a record would be kept demonstrating that the document had been offered and explained to the resident and that they sign to say that they do not wish to hold a copy. Any such agreements will need to be reviewed regularly and should be the exception rather than the norm. Assessment documentation in respect of a resident admitted since the last inspection showed that assessments were being carried out satisfactorily, that all relevant information from referrers and funding agencies had been sought and that the acting manager and staff team are part of this process. Prospective residents have the opportunity to visit the home look at the type of accommodation on offer and find out about day-to-day life in the home. These 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 9 visits are often carried out over a period of time to enable all of those involved including the prospective resident to decide whether the home is best suited to their needs. Residents’ needs are kept under review regularly. However the home does not always ensure that multi-disciplinary assessments are carried out when a resident’s needs increase. The home tends to put their own measures into place to safeguard residents and these are not always appropriate in a social care setting. The needs of one person were discussed during the inspection and the home were unable to demonstrate that an appropriate reassessment of their needs had been carried out involving all relevant health and social care professionals. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 10 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): 6,7,9and 10 Whilst the content and phraseology of care plans has improved the home cannot demonstrate that residents are fully free to make their own decisions and life choices. EVIDENCE: All residents had a written plan of care. Residents had been given the opportunity to hold their own plans however some had declined. It was agreed that a written record would be kept of this and that this would be reviewed regularly. Care plans continue to be reviewed on a regular basis. The acting manager had introduced changes and improvements to the format, layout and content of care plans since the last inspection and there was an improvement in the language and phraseology used within plans. Risk assessment and associated risk management plans had been reviewed and were much more detailed than at the last inspection and provided much more information and guidance than previously. There remains however further room for improvement in some areas regarding the wording and manner in which care plans reflect and demonstrate that residents are free to make their own decisions and life choices. In discussion with residents and from the wording used in some plans this cannot still be 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 11 fully demonstrated. There do remain concerns regarding the level of restrictions at times placed upon service users. Whilst it is accepted that the home has a duty of care and generally restrictions are placed upon people with this intent, they do at times encroach on the individuals’ rights. The home continues to use some language, which is oppressive and does need to be challenged. In respect of one resident, restrictive measures had been put in place to prevent the person from leaving the home, when considered a risk to themselves. Documentation referred to incidents of the person ‘absconding’ from the home, staff were also overheard to use this phrase as was the resident them self. This is an example of culturally used and accepted phraseology within the home and a way of thinking that is neither acceptable nor is it in keeping with a social care setting. Particularly as no resident at the time of this inspection was subject to any form of section under the Mental Health Act. This contradicts with residents’ contracts, which state that, “The home cannot restrict residents movements”. Other examples of restrictive practices were found and discussed during feedback at the end of the inspection. This issue has been raised at two previous inspections. Resident’s records are kept confidentially and residents said that staff respected their right to confidentiality. The inspector observed staff to respect this right throughout the inspection. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 12 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): 13,14,16 and 17 Residents have the opportunity to engage in and pursue their own interests, leisure activities and access the community. EVIDENCE: The home is within close proximity to public transport including a train station and a bus ride away from Southampton city centre or the nearby Bitterne shopping centre and other amenities including banks, post offices, and leisure facilities. Residents are supported and encouraged to access the local and wider community. While the home can and does provide transport residents are encouraged and supported to use public transport to promote their independence. Residents have the opportunity to engage in and pursue their own interests and leisure activities and their rooms reflect their individual tastes and preferences. Since the last inspection all residents have been issued with keys to their bedrooms and so they can now lock their doors should they so wish. Residents reported that they were happy with the quality, quantity and standard of the food provided. Some residents cater for themselves and are 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 13 provided with a weekly food allowance and given support to shop and cook as is necessary. Others eat and cook communally and advice and support is offered to ensure that residents maintain a healthy diet. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Residents are fully supported with their physical healthcare needs. Residents’ rights regarding medication including the right to refuse are dealt with inappropriately. EVIDENCE: At the last inspection residents reported that there were restrictions regarding what time they could stay up until. There was not however any evidence from this inspection to suggest that any such measures were still in place. Residents confirmed that they were supported to attend healthcare appointments as necessary and had access to a range of services such as, GP’s, dentists and psychiatric services. Healthcare records were well maintained, records of all appointments are kept including outcomes to ensure residents’ healthcare needs are fully met. Residents healthcare support needs are recorded in their care plans and reviewed on a regular basis. The acting manager had reviewed the procedure and facilities for residents to self-medicate since the last inspection. Procedures had been written to enable residents to work through different stages of self-medication at their own pace until they were fully able to manage this themselves if they so wish. The manager reported that this procedure needed some slight modifications before it was put into practice. In discussion it was reported that one resident was 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 15 ready to work through these stages although this had not yet commenced. It was agreed that this would be implemented by the end of April at the latest. Once fully implemented this should provide residents with the opportunity to manage their own medication in a safe and managed manner. In discussion with one resident they felt that they had been coerced into taking their medication by the fact that staff had refused to leave their room until they had been observed to take it. Whilst the home has a responsibility and duty of care towards residents this in not in keeping with the resident’s right to refuse medication. In such instances it would be expected that the reasons for refusal are recorded and that this is then referred to the appropriate health professional. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 16 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): 23 Residents feel safe and are protected by the homes’ policies and procedures. EVIDENCE: A requirement was made at the last inspection regarding the suitability and placement of one resident and the fact that residents felt unsafe and that the home had been slow to move this person on. This situation is no longer applicable and evidence from the assessment material discussed on page 9 of this report would demonstrate that this is less likely to occur in the future. All residents spoken with said that they felt safe and protected. Incidents within the home are appropriately documented including any occasions that physical restraint is used. By and large restraint is seldom used and de -escalation techniques are used as a means of avoiding this. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26 and 30 Improvements to the physical environment have made the home a more homely and safer place to live in. Safety and comfort are however jeopardised by poor fire precautions and inadequate heating. EVIDENCE: The requirement from the previous inspection to make the pond safe had been met within the agreed timescale and a fence had been erected around the pond. Lighting had been improved within the garden area to provide more safety. Improvements were also noted in communal areas. Flooring had been replaced in the dining area and some new carpets had been laid. Residents informed the inspector that the lounge was due to be redecorated and that they had chosen the colours themselves. Work was also due to commence on improving and revamping the upstairs meeting room as recommended at the last inspection. When completed this will provide an additional small lounge, a place to hold formal and informal meetings and somewhere to do activities such as arts and crafts. At the time of the inspection the home’s heating and hot water system was out of action. The home was cold and a service user and staff remarked upon this. The inspector was informed that this was a regular occurrence and that repairs had been made to the boiler several times and that it continued to break down. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 18 This was clearly unacceptable and an immediate requirement was made that this be rectified immediately. A further point of concern regarding safety within the home was that two resident’s bedroom doors were being propped open with chairs. Staff reported that one resident had agreed with them to have their door propped open as they were at risk of self harm and needed to be observed at all times. This included throughout the night. It was reported that the second resident preferred to have their door held open. This is clearly unacceptable practice and jeopardises the safety of all residents should a fire break out. An immediate requirement was made. Residents are able to personalise their bedrooms rooms with their own belongings and pursue their own interests. As the home is not fully occupied at present work was being carried out on vacant rooms to improve the insulation and décor. The only issue of concern regarding facilities in residents’ bedrooms was that they do not all contain lockable storage facilities. These will need to be provided to enable residents to be able to keep any personal items or medication safe. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 36 The home maintains adequate staffing levels and provides appropriate support, supervision and training to ensure that staff provide a good standard of care. EVIDENCE: The level of in-house training and induction is good. Records of a member of staff employed since the last inspection demonstrated that they had been through a thorough planned induction process and had attended training in food hygiene, a 4 day ‘appointed persons’ first aid course and different aspects of mental health training. Staffing levels are adequately maintained and appropriate to the level of residents’ needs at any given time. If a resident requires additional support then staffing levels are increased accordingly. There have been several changes made to the staff compliment since the last inspection and improvements were noted such as the appointment of an assistant manager and team leaders. This has meant that the acting manager can spend more time overseeing the running of the home. As a result staff are now receiving better support and frequent supervision. Staff recruitment records are now held within the home as required at the last inspection. The inspector viewed the files of newly appointed staff and was satisfied that all appropriate checks and documentation were in place. Protection of Vulnerable Adults and Criminal Records Bureau checks had been completed and references had been obtained. Residents told the inspector that staff were respectful, polite and supportive. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 20 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): 38 and 42 The home is well managed. Whilst safety is promoted, some practices within the home put residents at risk. EVIDENCE: The management arrangements were satisfactory. The previous acting manager has left the home since the last inspection and has been replaced. An application to register the new acting manager has been submitted to the Commission for Social Care Inspection. The acting manager is at the home for a sufficient time each week to oversee the day-to-day running of the home and reports directly to a senior manager within the Truecare organisation. Requirements from the previous inspection had been met within agreed timescales. Residents reported that they considered the manager to be supportive and approachable. One person commented that it was, “ Nice to have a consistent manager”. Whilst the home was generally safe there were concerns regarding fire safety, the lack of adequate heating or hot water as previously discussed. 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X X 3 X X X 1 X 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 22 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 Standard YA3 Regulation 14 Requirement That a review of the needs of the service user discussed in standard 3,6 and 20 of this report is completed. This review must involve professionals involved in their care, such as a care manager. Appropriate action must then be taken. You must ensure that any restrictions regarding residents’ rights are with the full agreement of all professionals and records are kept of this. You must consult with the fire authority and take all necessary action to safeguard residents from the risk of fire. Evidence of the fire officers advice / report must be submitted to the Commission for Social Care Inspection. You are required to take whatever action you consider necessary to ensure that the home is adequately heated and that there is a sufficient supply of hot water available. All residents must be provided with lockable storage. Timescale for action 30/04/06 2 YA6 15 30/04/06 3 YA24YA42 23 (4) 14/03/06 4 YA24YA42 23 (2) 14/03/06 5 YA26 16 (2) (c) 30/04/06 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 24 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 26 Chafen Road DS0000061570.V252104.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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