Inspection on 19/04/06 for Botchill House

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Botchill House 18/11/05

Botchill House 24/05/05

Botchill House 01/12/04

Botchill House 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Botchill House Hennesford Lane Dawlish Devon EX7 0QX Lead Inspector Mark Sharman Unannounced Inspection 19th April 2006 10:00 Botchill House DS0000003658.V289018.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 Botchill House DS0000003658.V289018.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. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Botchill House Address Hennesford Lane Dawlish Devon EX7 0QX 01626 863047 01626 863047 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) Havencare (Plymouth) Mrs Victoria Hales Care Home 15 Category(ies) of Learning disability (15), Physical disability (15) registration, with number of places Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 18/11/05 Brief Description of the Service: Botchill House is registered to provide accommodation with personal care to adults 18 to 65 years of age with learning disabilities and/or physical disabilities. The age range of current residents is from early forties to midfifties. Accommodation is over two floors and all residents have a single bedroom, one bedroom being on the ground floor. Communal areas include two lounges, a dining room and a large activities room. There is no lift. The building itself is a large detached property standing in its own extensive grounds, which include a garden, patio area and large orchard. There is a sizeable car parking area. The home is located in an attractive rural position about two miles from Dawlish. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and about seven hours were spent in the home. Time was spent in discussion with the assistant manager (in the absence of the registered manager) and with some of the staff on duty. Time was spent in the company of several of the residents, although it was not possible to communicate verbally with most of them. A sample of care records was examined, and a tour of the whole building was made. Some completed comment cards were received from residents’ relatives. What the service does well: What has improved since the last inspection? One requirement was made at the last inspection that a written record of all visitors to the home must be kept (in the interests of the security of all), and this had been complied with. One of the staff now acts as the activities coBotchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 6 ordinator, and the activities provided within the home have been expanded. In this respect the well equipped activities room has proved of great benefit to the residents. Recently some new equipment has been obtained such as a large screen for films, a snooker table, table hockey and table football. 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. Botchill House DS0000003658.V289018.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 Botchill House DS0000003658.V289018.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): 2. Quality in this outcome area is good. A prospective new resident’s needs would be assessed prior to his/her admission to the home. EVIDENCE: There is a robust admissions procedure in place which requires the management to carry out a pre-admission assessment of a prospective new resident’s needs in his/her own environment. However there has been no new admission to the home for many years, and so there is no recent evidence whereby this Standard can be judged in practice. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. Care planning is systematic and thorough and care plans are updated to reflect changing needs. Residents are helped to take part in a range of activities, some of which involve an element of risk. EVIDENCE: A sample of residents’ individual files was inspected and there was a care plan for each resident. These included an informative pen picture of the resident and summary of his/her preferred daily routine. The care plans had been reviewed six monthly, and each review was followed by a written action plan. The action plans covered the resident’s needs in respect of health care, personal care and social care. There is now also regular input into the care planning review process by the home’s activities co-ordinator in order to monitor the value of activities to each resident. Care planning was discussed with the assistant manager, who has responsibility for its co-ordination. He is involved with all care plan reviews, which are arranged in a flexible way to suit the particular resident. For example a review was to take place the following week in a local pub, to include the resident and his father. The residents’ individual files contained a number of risk assessments relating to activities which they take part in. In this way they are enabled to enjoy a wide range of activities which may involve an element of risk. For example the Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 10 daily programme sheets showed that a few residents regularly go swimming and horse riding. They all have free access around the home, and many of them moved freely about the building and the grounds throughout the day. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. The residents have opportunities to pursue their particular interests and to engage in activities in the local community, both of an educational and recreational nature. The catering arrangements are satisfactory and they are encouraged to eat healthily. EVIDENCE: Paid work and work placements are not a realistic goal for the current residents. However a good deal of effort is made in providing appropriate activities for them. There is a budget for activities and one of the staff is designated as the activities co-ordinator (not available on the day of the inspection). There is a written programme for each resident for each day of the week, and a sample was seen. Activities include educational courses at local colleges, and currently three residents are doing cookery and three are doing art therapy. There was a busy atmosphere in the home on the day of the inspection, and use was being made of the activities room. This is used for many purposes including arts/crafts, games, exercises, dance and independent living skills (it includes kitchen equipment). Two residents went out with staff in the morning to do the main food shopping for the week, combined with having lunch out. Others also went out with staff at various times of the day (one for a massage), and three were due to attend a club in the evening. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 12 The assistant manager said that most of the residents are in regular contact with relatives, for example one rings her mother each evening. Staff help to maintain contact by providing transport if necessary (the home has two vehicles). One resident is regularly taken to see his mother, and some relatives are picked up by staff to visit the home. The catering arrangements are satisfactory, and within reason residents are encouraged to eat healthily. The assistant manager discussed methods used to try to ensure healthy eating. The sample menus provided appeared to show a good variety of meals, and staff spoken with said they felt that residents eat well. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Personal support is provided by staff in a way that maintains the dignity of the residents. Their health is monitored carefully, and there is a safe medication system. EVIDENCE: The staff on duty (apart from one who had just started working at the home) were knowledgeable about the residents’ likes, dislikes, preferences and idiosyncrasies. The pen picture in respect of each resident in their personal files provides useful information for staff about each of them. There is a key worker system whereby a named staff member has particular responsibility with regard to the needs of one (or more) residents. Throughout the inspection the staff interacted with the residents in a friendly but respectful way. Help is provided with personal hygiene and choice of clothing, and the residents were appropriately dressed. All the residents are registered with a local general practitioner, and have an annual health check and a six monthly dental check. Recently regular chiropody treatment has been arranged within the home for all residents. Each of the individual files inspected contained an up to date health action plan. The medication system was discussed with the assistant manager. None of the residents can reliably look after his/her own medication. There is a good quality medication cupboard, with separate storage for controlled drugs. The medication blister packs and the medication administration recording sheets Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 14 were found to be satisfactory. Medication training is provided, and new staff do not administer medication to residents. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. There is a complaint system and satisfactory arrangements for protecting residents from abuse. EVIDENCE: Most of the residents themselves have very limited (or no) verbal communication. Thus the ability to communicate with them is particularly important, and it was evident during the inspection that the staff on duty have developed this ability fairly effectively. Communication books are used with some residents (one was seen). Training in communication is provided at the organisation’s head office. Staff spoken with said that they generally know when a resident is unhappy, via their body language or behaviour. The home’s written complaint procedure was displayed in the hall. No complaint has been made to the Commission for Social Care Inspection since the last inspection. The home has written policies on the protection of vulnerable adults, including a whistleblowing policy. The staff spoken to were aware of these policies and of where they are kept, and in fact a new staff member (on her second day in the job) was reading the policies folder on the morning of this inspection. Vulnerable adult training is provided for staff, and the assistant manager said that NAPPI refresher training is given (non-abusive psychological and physical intervention). Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30. Quality in this outcome area is good. The home is comfortable, spacious and safe and was found to be clean. The décor is good, with the exception of three bedrooms. EVIDENCE: The home is well located outside Dawlish, enabling the residents to enjoy the immediate vicinity in reasonable safety. This includes a small paddock and a large orchard. (The home has some ducks in the orchard which provide an interest to certain residents, and there is a plan to obtain some chickens as well.) The standard of accommodation in the home is very good. All residents have a single bedroom. These were seen during the inspection and they are all of a good size. Most are attractively decorated and comfortably furnished, although three are now in need of redecoration (as pointed out to the assistant manager). The residents benefit from a lot of communal areas including two large lounges, a dining room and a large well-equipped activities room. The assistant manager said that the kitchen will be completely refurbished in the current financial year. The building was clean (including WCs and bathrooms) and without odour, and there is an excellent laundry room equipped with two commercial washers and two dryers. The cleaner was working on the morning of the inspection. There are policies and procedures for infection control. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 17 Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 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 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, 34 and 35. Quality in this outcome area is adequate. There is a good core of experienced staff but the home has difficulty in recruiting new staff. There are good training opportunities, although the NVQ target has not yet been met. EVIDENCE: There was a good number of staff on duty at the time of this inspection. The staffing rota was inspected. Staff said that generally there are enough staff on duty but that the home does have some staff vacancies. This was also reported in a recent Regulation 26 report and commented on (via comment card) by a resident’s relative. In common with many other establishments the home has difficulty in recruiting new staff. Two of the current staff are to leave soon. All of the staff spoken with said that the organisation offers good training opportunities, and one said that he had attended several training sessions in the few months he had worked at the home. The training programme for this year was inspected, which listed a wide range of training appropriate to this client group. The new staff member said that she is to have approved (LDAF) induction training. The 50 NVQ target has not yet been achieved, but the home has made progress in this respect (about 35 of care staff). With regard to recruitment three files were examined in relation to fairly new staff. All contained two written references and evidence of induction training having taken place. There were also some appropriate training certificates available as evidence of training. However in none of these cases was a Criminal Records Bureau disclosure available, although the assistant manager Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 19 was confident that they had been received by the organisation. Some older disclosures were available in relation to other staff. Botchill House DS0000003658.V289018.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): 37, 39 and 42. Quality in this outcome area is good. The home has an experienced manager and there is support and supervision from head office staff. There are a number of strategies for monitoring quality. Health and safety arrangements are satisfactory. EVIDENCE: The registered manager has been a qualified learning disability nurse since 1992. She has been in a managerial role within a range of learning disability services for many years. She is currently undertaking the NVQ registered manager award, and the Standard will be fully met when this is completed. There are a number of strategies for monitoring quality. Staff meetings are held regularly, and the minutes of the last meeting (24/03/06) were available. Client care meetings are also held. An inspection of the home has been made by head office staff each month since the last inspection as required by the Regulations, and a report sent to the Commission for Social Care Inspection. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 21 Twice a year there is a “family and friends” day at the home for relatives and friends, last held in December 2005. With regard to health and safety issues assessments of each resident are carried out in respect of their vulnerability (a sample was seen). The fire log was inspected and showed that staff had professional fire training in February this year. All radiators accessible to residents have low surface temperature covers, and the hot water supply to the baths and washbasins is temperature regulated. These measures should prevent residents from suffering burns or scalds. Upstairs windows are restricted to prevent accidental falls. An environmental health officer inspected the home 25/01/06 and concluded that it was “satisfactory” in relation to food safety and health and safety. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 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. 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 4 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 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 2 x 3 x x 3 x Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA26 YA34 Good Practice Recommendations Three of the residents’ bedrooms should be redecorated, as pointed out to the assistant manager. Criminal Records Bureau disclosures in respect of all staff should be kept in the home until the next inspection by the Commission for Social Care Inspection. Botchill House DS0000003658.V289018.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Botchill House DS0000003658.V289018.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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