Inspection on 05/05/05 for Appleton House

This inspection was carried out on 5th May 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Appleton House 07/06/06

Appleton House 13/03/06

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 Manor Southampton SO18 1BB Lead Inspector Chris Johnson Unannounced 5 May 2005 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. 26 Chafen Road Version 1.10 Page 3 SERVICE INFORMATION Name of service 26 Chafen Road Address Bitterne Manor, Southampton SO18 1BB 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) 023 8028 6290 Truecare Group Ltd Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number demential of places 26 Chafen Road Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Mental disorder, excluding learning disability or dementia Date of last inspection 14/2/05 Brief Description of the Service: 26 Chafen Road also known has 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection that took place over two days. The purpose of this visit was to carry out an inspection of the home and follow up on requirements made at the last inspection. The acting manager assisted the inspector throughout the first day of the inspection. Staff and care records were inspected. Four of the six residents currently living at the home were spoken to, as were several members of the staff team. What the service does well: What has improved since the last inspection? Very little has improved since the last inspection. Several of the previous requirements have not been met. The only obvious improvement is that a new medication system was being introduced into the home. This will mean that all medicines are received from the same pharmacist and staff will therefore only have one system to contend with. This will mean that the chances of mistakes being made should be reduced. 26 Chafen Road Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 26 Chafen Road Version 1.10 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 26 Chafen Road Version 1.10 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) 1,2,4 and5 Whilst the staff team endeavour to meet the needs of the residents this at times hampered by people being inappropriately placed in the home. Residents are unclear about their rights. EVIDENCE: Residents had still not been issued with a Service User Guide to the home and although they had all signed contracts informing them of their rights they did not hold copies of these. Residents were unsure about the existence of their contracts and seemed unsure of their rights. One resident said, “I am not really aware of what I can and cannot do”. The acting manager explained that contracts had been sent to funding agencies and that they would be issued to residents once returned. It was noticed that the contract does not state the room to be occupied by the resident and this detail should be included. No new residents had moved in since the last inspection. It was therefore not possible to make a judgement as to whether the assessment process had been improved since the last inspection. Many referrals come from other homes within the Truecare organisation. The manager of the home does not deal with referrals and is not involved in the initial assessment process. A senior member within the Truecare organisation carries this out. This would appear to be a flaw in the assessment process, resulting in people being placed at the home whose needs the home cannot meet. This was emphasised by the fact that a resident, whose needs could clearly not be met by the home had attacked a 26 Chafen Road Version 1.10 Page 9 member of staff the previous evening. This was the second occasion that this had happened. At the last inspection in February the inspector was informed that the resident was awaiting a more suitable placement following an attack on a staff member and threatening behaviour to residents. From inspection of care notes, talking to residents and staff it was evident that this was having a detrimental effect on the individual, the other residents and the staff team. As part of this procedure prospective service users and or their representative 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. Service users confirmed that they had been given this opportunity and that this assisted them in making their choice of home. All residents said that they felt that their needs were met in the home and that the staff were supportive and responsive to their needs. This was observed to be the case throughout the inspection. 26 Chafen Road Version 1.10 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 standard(s) 6,7,9 and 10 There is a contradiction between policy and procedure in the home. This results in a culture of restrictive practice causing confusion and at times anxiety for residents. At times residents are consulted and at other times there would appear to be little consultation. Confidentiality is generally respected and promoted. However this is at times compromised by poor practice. EVIDENCE: A written plan of care was in place for all of the residents. These detailed their support needs in respect of their physical and mental health, social, educational and employment needs. Each resident has a key worker allocated to them, whom meets with them on a regular basis to discuss and review their needs. Residents said that they were given a choice regarding which staff member they would prefer to be their keyworker. Residents do not however hold a copy of their own care plan and two of the four residents spoken to said that they were unsure whether a care plan was in place for them. This issue was raised with the acting manager and no reason was provided. Care plans did in general cover the salient points of each persons care needs with specific guidance for staff to follow should the person require support. Several care plans had a section under the heading ’escorted/unescorted leave’. These contained guidelines for staff as to the frequency, time and 26 Chafen Road Version 1.10 Page 11 places that residents could go unescorted. No justification was provided for such restrictive practice and there was nothing to suggest from risk assessments as to why this should be. Further more, no resident at the time of this inspection was subject to any form of section under the Mental Health Act. This conflicts with residents’ contracts, which state that they are free to come and go from the home and impinges on their rights. This issue was raised at the previous inspection. Residents are however consulted about other aspects within the home and are able to contribute to decision making by means of regular house meetings. Resident’s records are kept confidentially and residents said that staff respected their right to confidentiality. However during the inspection one staff member was observed to take a resident’s medication into the dining room and administer it in front of other residents. This is clearly not good practice and was brought to the manager’s attention. 26 Chafen Road Version 1.10 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 standard(s) 12,15,16 The opportunities for residents to engage in their own interests and maintain relationships with family and friends are good. Residents’ rights however are often not respected due to restrictive practices. EVIDENCE: Residents are supported to attend a range of educational and leisure activities of their choosing. All residents spoken to said that they were happy with the level of support that they were given to pursue their interests. Residents said that they were free to receive visitors and that they could invite visitors to dine with them. Residents have use of a meeting room if they prefer not to invite visitors into their own rooms. This room could however be made more comfortable and homely by the removal of filing cabinets and some additional soft furnishings. One resident commented that they enjoyed being able to entertain their visitors. Residents felt that their privacy was respected. All said that staff always knocked their doors and waited to be invited in. One person said, “staff always knock and wait for you to answer. They don’t just walk in. If you want to spend time alone you can”. Staff were observed to interact with residents in a relaxed, friendly and respectful manner. 26 Chafen Road Version 1.10 Page 13 There were however some further points of concern regarding residents’ rights and restrictive practices. It was noticed that residents could not gain access to the laundry room without supervision. The door was locked and a notice stated that access was not permitted. When questioned the manager said that this was due to the needs of one resident. There was not however any reason given as to why all remaining residents could not have access and the resident concerned was any longer at the home. Residents although able to lock their doors from the inside do not hold keys to their rooms and are therefore unable to lock their rooms should they so wish. This again was unnecessary as no reason was put forward as to why this should be and means that residents cannot safeguard their belongings. Further more, during the inspection several staff members from another home within the Truecare organisation arrived uninvited to eat their lunch at the home prior to some of them attending a meeting at the home. This was unfair on the residents at Chafen Road and did not demonstrate that their rights are always respected. One resident told the inspector that they were unhappy about the situation. 26 Chafen Road Version 1.10 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 standard(s) 18 and 20 Whilst residents are afforded a certain level of choice, they are often constrained by unnecessary rules and regulations, which do not seem to serve any purpose. EVIDENCE: Residents seemed to be unclear regarding certain house rules. Some reported that there were restrictions regarding what time they could stay up until. The general consensus was that they were expected to be in their rooms by 11.30pm on weekdays and 12.00pm at weekends. One resident said, “ It has always been that way. I’m not sure why. I don’t see why it is like that. After all it is supposed to be independent living. If I lived on my own I wouldn’t have to do that”. The manager was unable to offer a concrete answer to this and there was nothing written in either their contracts or care plans to justify such a restriction. Further restrictive practices were recorded in the daily log whereby it stated that a resident had been told that they could not smoke a cigarette at 12.30am. Residents had still not been provided with lockable storage for their medication, as required at the last inspection. The manager did say that these had been obtained and were due to be installed. However the manager did not intend to issue residents with keys to their cabinets, despite it being recorded 26 Chafen Road Version 1.10 Page 15 in some resident’s files that they were self medicating. Several residents spoken to were under the impression that they would hold their own key. There had been a review of the home’s medication system as required at the previous inspection and a new system was due to be introduced and associated training had been organised for staff. This should reduce the likelihood of errors being made. Residents reported that they were happy with the support that they received with their medication. One person commented,” the staff are very good. If I forget they always remind me. That makes me feel safe”. 26 Chafen Road Version 1.10 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 standard(s) 22 and 23 Staff treat residents with respect and are committed to protecting them. However the home is slow to take action to move people whose needs they cannot meet which can leave residents very vulnerable. EVIDENCE: All residents said that they felt safe, protected and that the staff treated them well and with respect. They did however feel that the placement of one resident in the home had threatened the safety of the home. There were found to be many recorded incidents of one particular resident behaving in a threatening manner towards staff and residents. Although this resident had now been removed from the home it had taken several months to do so. Residents felt confident that they had someone that they could raise any complaints to and were aware of reporting procedures. 26 Chafen Road Version 1.10 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 standard(s) 24 Standards of hygiene are maintained. There is room for some improvement to the physical environment. EVIDENCE: The physical environment was not inspected in any detail on this occasion and will be looked at in greater depth at the next inspection. The home appeared to be clean and tidy. The only cause for concern was that there was not any barrier to prevent someone falling from a decked area in the garden into the pond. This will need to be rectified, as there is a risk of someone stumbling and especially to residents that are prone to have seizures. 26 Chafen Road Version 1.10 Page 18 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) 31,33,34 and 36 The home has a dedicated staff team. Management support must be improved however to increase staff morale and to ensure that residents are protected. EVIDENCE: Staff morale was quite low at the time of this inspection, due to recent events in the home. There was a level of frustration within the staff team regarding the length of time that it had taken to move a resident whose needs could not be met by the home to alternative accommodation. Staff had not received one to one supervision for a long time. The manager reported that there was insufficient time to fulfil all of his responsibilities such as supervising staff. Although the home was being staffed by sufficient numbers there had not been a deputy manager at the home since October. Neither had there been any team leaders. This had resulted in the manager having insufficient time to fulfil his role. It was also apparent that a disproportionate amount of time had been spent in supervising and supporting the resident discussed previously. The staff team are clearly dedicated to supporting residents but have been finding it increasingly difficult to do so. There were concerns regarding the recruitment records of staff as these were not available in the home, despite there being adequate storage space and an obligation to hold these. The manager attempted to get them from Human Resources but they could not be located. This was a cause for concern as the home was unable to demonstrate that Criminal Records Bureau checks had 26 Chafen Road Version 1.10 Page 19 been obtained, that a check against the Protection of Vulnerable Adults list been made or that references had been obtained. All of these must be obtained and held within the home to ensure the protection of service users. 26 Chafen Road Version 1.10 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 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) 42 The home adheres to health and safety procedures. EVIDENCE: The home appeared to be safe and from inspection of the fire log book regular and thorough testing of the homes fire detection equipment had taken place. Hazardous substances were safely stored and standards of hygiene were being maintained. 26 Chafen Road Version 1.10 Page 21 26 Chafen Road Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 x 3 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 1 x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x 3 1 x Standard No 31 32 33 34 35 36 Score 3 x 2 1 x 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x 26 Chafen Road Version 1.10 Page 23 Yes 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 1 Regulation 5 Requirement All service users must be given a copy of the service user guide. (Previous timescale of 30/4/05 not met) Thorough assessments must be completed prior to admitting service users to the home. As part of this assessment the needs of existing residents must be taken into account. All service users must be given a copy of their contracts. This must include the room to be occupied, fees and terms and conditions of tenancy. (Previous timescale of 30/4/05 not met) The home must review all service user plans. Service users must hold copies of their service user plans unless there are clear recorded reasons not to do so. The home is to provide the Commission for Social Care Inspection in writing the reasons for the restrictions being placed on service users regarding ‘periods of leave’ from the home, and restrictions around bed times. Version 1.10 Timescale for action 01/10/05 2. 2 14 01/10/05 3. 5 5 (1) (c) 01/10/05 4. 5. 6 6 15 (2) (b) 15 (2) (a) 01/10/05 01/10/05 6. 7,9 and 18 15 07/10/05 26 Chafen Road Page 24 7. 8. 10 16 12 (4) (a) 12 (4) (a) 9. 20 13 (2) 10. 11. 12. 13. 14. 23 24 34 34 36 13 (6) 13 (4) (a) 19 (1) (b) 17 (2) Schedule 4 (6) 18 (2) Confidentiality must be maintained at all times. All service users to be offered keys to their rooms, unless there is a risk assessment in place to demonstrate why this is not appropriate. Review all service users medication administration. Service users who have been risk assessed as being able to manage their own medication and his has been agreed with the appropriate medic must be permitted to do so.(Previous timescale of 30/4/05 not met) You must ensure that service users are protected at all times. The garden pond must be made safe. Staff must not commence work at the home until all satisfactory checks have been made. All staff records listed in schedule 2 must be held at the home. All staff must receive regular supervision. 07/05/05 01/10/05 01/10/05 07/05/05 01/10/05 07/05/05 01/10/05 01/10/05 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. Refer to Standard 15 Good Practice Recommendations That the meeting room is cleared of all office furniture and made more homely for service users to entertain their visitors. 26 Chafen Road Version 1.10 Page 25 Commission for Social Care Inspection 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 Version 1.10 Page 26 - 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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