Inspection on 14/09/05 for Bourne House

This inspection was carried out on 14th September 2005.

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

Other inspections for this house

Bourne House 22/05/07

Bourne House 08/05/06

Bourne House 30/01/06

Bourne House 04/01/05

Bourne House 13/07/04

Bourne House 16/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Bourne House 119 Mersea Road Colchester Essex CO2 7RL Lead Inspector Jenny Elliott Draft Unannounced Inspection 09:30 14 & 17th September 2005 th Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bourne House Address 119 Mersea Road Colchester Essex CO2 7RL 01206 577678 01206 578581 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) The Essex Autistic Society Mrs Terry-Ann Webster Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 04/01/05 Brief Description of the Service: Bourne House, a family sized home, was opened in September 2002 by the Essex Autistic Society. The house provides accommodation and care for up to four adults with autism. The house is well decorated and furnished. There is a garden to the side of the house providing some privacy for service users. The service has good links with educational establishments and leisure services in Colchester, to the benefit of service users. The house is within walking distance of Colchester’s main shopping area. Small shops and health services are very close to the house. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out in line with the regulatory requirements of the Care Standards Act. The home was visited on the 14th of September 2005 where records were inspected and discussions held with the registered manager. A second visit was made on the 17th September 2005 to spend time with service users and staff. About 5 hours was spent in total on these activities. What the service does well: What has improved since the last inspection? Plans of care for service users have been improved, providing clear direction for staff and presenting information in a manner that is more accessible to staff and service users. The development of an Induction/Training/Supervision policy has helped to ensure that practice is underpinned with knowledge in many areas. The EAS has employed a Clinical Psychologist to assist with its work with people using its services, Bourne House have made good use of this. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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): These standards were not inspected, no new service users had been admitted to the home since the last inspection. EVIDENCE: Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 & 9 Individual plans were developed in a person centred way meeting the individual needs of, and choices made by people living at the home. EVIDENCE: New care plans had been implemented for all service users. Two plans were inspected in detail. The new format presented information in a more accessible format for staff and service users. Clear information was provided in the homes assessment of needs from which care plans were devised, sheets were not always signed or dated, making it difficult to assess the currency of those assessments. Support plans provided very clear direction to care staff about e.g. how people living at the home were supported to access the community, supported with behavioural issues and sensory issues. Not all of the needs identified at assessment had corresponding support plans. Each support plan was dated and included the name of the member of staff compiling the plan. Each support plan had an associated risk assessment in place, although some had not been reviewed for over a year. The records of infringement of rights for one person were all dated 1998, there was no indication that there had been any review since this date. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 the following standard(s): 12,13,15,16 & 17 People living at the home participated in purposeful activities outside and within the home. Staffing levels at the weekend and evening meant that trips out were often only possible on a group basis. EVIDENCE: People living at the home participated in a range of activities inside and outside the home. During the visit to the home on the 14th September two service users were attending educational courses and two receiving their weekly reflexology treatment at the home. Every person at the home had a weekly timetable of activities that included attendance at educational/day centre establishments, participation in leisure activities, household tasks and time to relax within the home. The manager described efforts that continue to be made with external services to increase the range of activities available to people living at the home. On the second visit to the home (Saturday midday) staff and people living at the home had just returned from a shopping trip, where people had chosen the ingredients for their lunch. Each person then prepared their own lunch (with appropriate support and supervision from staff) and cleared away their plates afterwards. The inspector was advised that as two staff were on duty that day there may be a choice of activities for Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 11 the afternoon. During this visit one member of staff went out, one service user asked if they could go too, another was asked if they wanted to go along but declined. During both visits the people living at the home appeared comfortable with their surroundings, the staff on duty and the routines of the home. The behaviour of people living at the home indicated that they were happy and not anxious. Staff displayed a good understanding of the needs of people living at the home, (in accordance with information previously seen in care plans), and were helpful in reducing any anxieties that might have occurred by the presence of the inspector. The behaviours of some of the people living at the home could affect the extent to which they could access the community, but support plans ensured that steps were identified to reduce any negative impact and to enable access in a safe manner. The staff rota for the four weeks beginning 15th August 2005 showed that on fifteen of those twenty eight days there was at least one part of the day with more than one member of staff on duty, increasing opportunities for people living in the home to participate in different activities. In that period there was never more than one person on duty at weekends and only two occasions where more than one member of staff was on duty in the evening. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 the following standard(s): 18,19 & 20 The service makes good provision for the physical and emotional wellbeing of people living within the home. EVIDENCE: As stated previously, care plans provided good instruction to staff about how to care for people living at the home, it was clear through the low level of challenging and anxiety provoking behaviour that this reflected the preferences of service users. The home makes good use of NHS professionals and the EAS clinical psychologist to support the development of appropriate care. Risk assessments were in place indicating that it was not appropriate for people living at the home to administer their own medication. The level of medication used at the home was low. Records relating to the administration of medication were complete. Four members of staff had completed training in respect of the administration of medication and seven had completed a foundation course entitled ‘Care of Medicines’. All of these training sessions had been undertaken within the last two years. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 the following standard(s): 22,23 The service listens to and takes step to protect from harm, people living in the home. The service does not adequately train staff in the protection of people living at the home. EVIDENCE: Interaction between people living and working at the home, observed on both inspection days, was good. People living at the home seemed comfortable around staff. People living at the home did not exhibit behaviours to indicate they were not being listened to. Service user meetings were held and notes kept of those meetings. Staff understood the importance of following through on actions agreed with people living at the home. One member of staff said ‘it is important to do what you say you will do’. No complaints had been received by the home or CSCI about the service. The home operates a robust recruitment process to ensure people working at the home are fit to do so. However training for staff in respect of the protection of vulnerable adults was not comprehensive. Four people had attended a foundation training course linked to the Learning Disability Award Framework (LDAF), three in 2004 and one in 1998. Four members of staff had not received any training in this area. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 the following standard(s): 24 & 30 The service is provided in a homely, clean environment. EVIDENCE: Only shared areas of the home were seen during this inspection. These were furnished and decorated in a homely manner. The condition of furniture and decoration was good. The areas seen were clean and no hazards were identified. A recent visit by the Environmental Health Officer had not identified any legal requirements or advisory actions in respect of the safety of food or health. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 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 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 & 35 Staff were competent and effective. Recruitment practice has historically served to protect people living at the home (no new staff had been recruited since the last inspection). Some gaps were identified in core training areas. EVIDENCE: The observation of staff throughout the inspection, supervision records and discussions with staff about the needs of people living in the home demonstrated a competent and effective staff team. Regular staff meetings and handover sessions were held within the home. Notes from staff meetings demonstrated that where difficulties arose they were addressed in an appropriate manner. The services recruitment policy (and historical practice) is robust. There had been no new staff recruited since the last inspection, so further assessment was not possible on this occasion. The service had developed an Induction/Training/Supervision policy since the last inspection. The policy outlined the purpose and outcomes of the induction process. The service’s induction process had been cross-referenced to nationally agreed standards, linked to the specific needs of people with a learning disability. Up to date training records were maintained by the EAS in respect of all staff, and provided to the inspector immediately after the inspection. The policy, referred to above, states the ‘skills and attributes of staff should be identified and recorded’, a clear skills assessment and training Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 16 needs profile was not seen other than in the record of training completed or planned produced on a staff team basis. In the training record provided there were some gaps in core skills training or refresher courses including, POVA, food hygiene and dealing with challenging behaviour. Four members of staff had achieved National Vocational Qualification (NVQ) Level 2 in Care and one person was working towards this award. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 17 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 The home was well run, but had experienced some difficulties in the early part of the year. EVIDENCE: The home has an experienced manager, who has recently completed a relevant NVQ level 4. Staff described the manager’s approach as supportive and open. It was identified during the course of the inspection that the manager was also managing another service and could be away from the home for up to two days a week. The CSCI had not been informed by the EAS that the manager was not in full-time day-to-day management of the home. It was also noted that a number of references were made earlier in the year to the impact this had had on the service. A report by the Societies Clinical Psychologist, dated June 2005 stated “…I wonder if the fact that [manager] has had to spend so much time away from Bourne House,…has contributed to [service user’s] increased anxiety levels.” There were two references in staff meeting notes to the absence of the manager and its impact on the staff team. The inspector Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 18 was satisfied that at the time of inspection steps had been taken to address the negative impacts of the managers reduced time at the home. However it is expected that the Society fully resolve the issue in a timely manner. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 19 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 X X X x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 4 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bourne House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X X X DS0000031952.V252617.R01.S.doc Version 5.0 Page 20 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 6 Regulation 15 Requirement The registered person must ensure that care plans address all needs identified through assessment. The registered person must ensure that the recording of risk assessments and infringements of rights accurate and regularly reviewed. The registered person must ensure that staff receive training appropriate to the work they are to perform. (Previous timescale of 31/10/04 not met) The registered person must, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times sufficient staff are on duty. (Previous timescale of 31st August 2004 not met). Timescale for action 30/11/05 2 9 17 (schedule 3),13 13,18 30/11/05 3 23,32,35 31/01/06 4 33 18 30/11/05 Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 21 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 Refer to Standard 37 Good Practice Recommendations The registered person should keep advise the Commission where there are significant changes in the day to day management of the home. Bourne House DS0000031952.V252617.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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