Inspection on 14/07/05 for Cana

This inspection was carried out on 14th July 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

Cana 23/01/08

Cana 21/09/06

Cana 22/11/05

Cana 14/12/04

Cana 23/06/04

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Insight - Eastchurch

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

CARE HOME ADULTS 18-65 Cana Chapel Hill Eythorne Dover Kent CT15 4AY Lead Inspector Chris Randall Unannounced Inspection 14 July 2005 - 09.00 hrs 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. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cana Address Chapel Hill, Eythorne, Dover, Kent, CT15 4AY 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) 01304 831739 LArche Miss Caireen Piper CRH 5 Category(ies) of Learning disability (LD) registration, with number of places Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14.12.04 Brief Description of the Service: Cana is situated in the village of Eythorne. It is a large detached property set back from the road towards the bottom of Chapel Hill, and almost next to the chapel. There is parking on the site for a maximum of 4 cars and additional, on street, parking can be found on Chapel Hill. The home is run by LArche, a christian based organisation with homes in many countries. Assistants are mainly students or assistants from other countries who live and work at the home, all have a good understanding of english. Service user accommodation is provided in five single bedrooms, one on the ground floor and the others at first floor level. There is also dedicated single room accommodation for assistants. There are communal spaces of lounge/dining room, T.V. lounge, and smoking room are all are used by both service users and assistants, as are the toilet and bathing facilities. The home has the benefit of garden space to the front and side of the property. The village is fairly isolated but does have a village shop and two public houses. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place over 8.5 hours, (4.5 hours in the home plus preparation time). All of the core members (the name preferred by the service users at Cana) were all out for the day at the time of the inspection, and therefore their comments and views on life at Cana are unable to be included in this report. The inspection consisted of a tour of the home, talking to the manager and 2 assistants, inspection of medication storage and examination of various records. The home was clean, comfortable, well maintained, and odour free. Many of the windows were open ensuring a comfortable temperature and free flow of air indoors despite the heat outside. Most of the requirements and recommendations from the last inspection had been addressed, although there are still two outstanding issues and these have been included as requirements at the end of this report. The home is registered to care for adults aged 18 – 65, one core member is over 65 and the home were advised to apply for a variation of their registration to cover this core member. Assistants comments included “I enjoy living and working in this community”, and “there is a friendly atmosphere” What the service does well: What has improved since the last inspection? Core members are now more involved in menu planning and choose the menu for the coming week at their weekly house meetings. The roof of the smoking Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 6 room has been repaired, and repairs to the roof of one core members bedroom have been carried out but water damage is still occurring and work will be done on this whilst all core members and assistants are away on holiday. Alterations and improvements have been made to some records, including revision of the service user guide and statement of purpose. Assistants who administer medication to core users are now properly trained. 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. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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 Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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, 3, 4, & 5 Prospective service users can be confident that their needs and aspirations will be assessed and they can have trial visits to the home prior to admission. EVIDENCE: The service user plan and statement of purpose for Cana have recently been reviewed and updated in accordance with the requirements made on the last inspection report. Prospective core members are met and assessed by the manager, and joint assessments are requested from care managers. These assessments are used to form the basis of a care plan. Any potential restrictions on choice are documented in individual risk assessments. The assessment process helps the home to be sure they can meet the assessed needs of prospective core members. As a Christian community Cana is particularly sensitive to core members spiritual needs. Although most of the assistants are foreign they all have a good command of English and are good at communicating using verbal and non-verbal skills. Prospective core members trial visits are built up, starting with an afternoon, then a day, an overnight, a weekend, a week and finally between a month and 3 months, to ‘test drive’ the home before any final decision is made on permanent occupancy. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 9 A written statement of terms and conditions, including pictorial interpretations of the text, is signed by each core member and is stored on their personal file. Amongst the details contained in the contract are details of the room to be occupied, the period of notice, support that will be provided by the home, and the fees payable. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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, 8, 9, &10 The individual needs and choices of core members are respected, they are consulted and encouraged to make decisions about all aspects of their lifestyle. EVIDENCE: Care plans, based on the information gained on assessment, are produced for all core members. These plans include very good personal profiles. The terms and conditions have been amended to address minor omissions as recommended in the last report. Currently care plans are reviewed with care managers annually. In house reviews take place 6 monthly with informal discussion in between times during staff meetings. It would benefit the process if these informal reviews were documented and copies kept on the individual files. It is recommended that core members or their representative sign and date the care plans and personal profiles following the six monthly reviews. Staffs encourage core members to make their own decisions about all aspects of their lives. There is a weekly house meeting where menus and chosen for the following week and where core users have the opportunity to air their views on any topic. Core members have the choice of what they have in their own personal rooms, including choosing their own new furniture when needed. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 11 They choose where they want to go for their holidays. They can choose how they wish to spend their personal money, including any wages earned from the workshops. There is a list of possible advocates available and the manager is currently producing this in a format understandable to the core members. Core members participate in the day-to-day running of the home. All keep their own rooms clean and tidy, with help available when needed. Home tasks undertaken include doing some of the monthly checks, putting out the rubbish, setting the table, emptying the dishwasher, tidying the communal rooms, drying the dishes, collecting the daily paper from the local shop, and 1:1 with assistants doing gardening etc. When a prospective new assistant comes to see the home they are shown around by one of the core members and members views are taken into consideration when deciding if the person is suitable for the position. The manager ensures that all risks are properly assessed and that risk management strategies are agreed and documented. Risk assessments include activities, holidays, and health and care matters. The home operates an effective confidentiality policy. All records are kept in a secure location. Information given by core members is treated with respect but assistants are aware of when information must be shared with management. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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, 13, 14, 15, & 17 Core members are supported to lead interesting, varied and fulfilling lifestyles. EVIDENCE: As there were no core members present at the time of the inspection this section was evidenced from documentation and discussion with the manager and assistants. All of the standards in this section will therefore be looked at closely again on the announced inspection later in the year, when, hopefully, core members views will be able to be reported Core members attend either craft or therapy workshops from Monday to Friday weekly. From an old ‘in between book’ it was witnessed that one core member has been enjoying becoming more proficient in weaving. Some of the core members receive wages from their attendance at these workshops and are encouraged to look after and account for this money in their own way. With Cana being situated in a small village the core members are very much part of village life and mix with the local residents at church, when visiting the local shop or pub, and when attending village events. Core members also mix Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 13 with the core members of the other L’Arche homes at their daily activities; at the monthly community events examples of which are strictly L’Arche dancing and the Halloween fancy dress concert, at Eucharist events such as the pilgrimage; and by visiting each others homes for suppers, birthday teas etc. L’Arche has 2 mini busses which they use to collect core members for the workshops and to take them out on outings. Assistants also take them out in the car. When there are special events taking place additional assistants are brought on duty to cover. Every year all core members choose where they wish to go on holiday either to go on one of the group holidays, stay with their families, or go to visit friends. Where the holiday chosen is not a group activity but requires additional support one of the assistants goes with them. These holidays are funded by L’Arche. This year, in addition to the normal holiday, the whole community of Cana have decided to go away for a week together and have rented a large house in Lyme Regis for a week in August, this holiday is part self-funded and part funded by the organisation. Some service users choose to take part in the political process and are taken by car to the polling station in the next village. None have chosen to take advantage of the postal voting system. Since the last inspection the choice of menu for the week has been introduced at the weekly meetings house meetings, photographs of how the finished dishes should look are shown and a choice is made. Core members are very involved in the cooking, of the food and in clearing up afterwards. The home has not yet introduced nutritional assessments for all core users as required on the last inspection report and this is restated on this report. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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, 19, &20 Core members are supported in maintaining their personal and healthcare needs. EVIDENCE: Although standard 18 was not fully assessed and will be looked at again at the next inspection, it is recommended that all appointments with health care professionals are recorded in the care plan (e.g. chiropody, optician or dental appointments). Core members are supported in gaining information and advice about health care matters, and in attending appointments with health care professionals. Any significant changes in health are monitored and reported to the G.P. or other relevant health professional when necessary. Currently only two core members are on prescribed medication, neither self medicate (other than to take tablets with them to the day workshop where they are reminded to take them). There are two individual medicine cabinets for storage, the home uses the dosette box system, prepared by the local chemist, the MAR sheets were properly filled in. The home operates a homely remedies policy and the G.P. has signed protocols for over the counter medicines. Assistants who administer medication have all attended training for this aspect of their employment. . Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 15 Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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 & 23 Core members are protected from abuse and are able to express any concerns they may have. EVIDENCE: The home has a clear and concise complaints policy and a copy is displayed on the notice board in the hallway. All complaints are recorded, together with the outcome of their investigation. Core members are all made aware of how to make a complaint, however there have been no complaints lodged since the last inspection. The home also has policies on abuse, and whistle blowing. All assistants are taught about adult protection issues during their induction. The home has a copy of the new adult protection protocols recently issued by Kent County Council, and are currently reading through this. All assistants have CRB and POVA checks prior to appointment, and the manager understands the necessity to refer to the Protection of Vulnerable Adults register should the need ever arise. During induction assistants are taught how to deal appropriately if any core member presents signs of physical and verbal aggression towards them or another core member. Any pocket money which is kept by the home for safe keeping is kept in a secure place and all transactions are recorded. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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, 26, 27, 28, &30 The general environment at Cana is comfortable and homely but repairs needed to the structure of the home are not completed with sufficient urgency. EVIDENCE: The home is comfortable and bright, with suitable furnishings and fittings, and there are no offensive odours. The building is owned by a housing association, and maintenance issues to do with the structure of the home is their responsibility. The requirement to repair the roof to the smoking room has been acted on, however the wall still needs to be re plastered. With regard to the requirement to remedy the damage caused by water ingress in one core members bedroom, although the chimney has been repaired the problem has not been solved. It is now thought that there is probably a leaky pipe situated in the wall and the housing association has planned to investigate and rectify this problem whilst the service users are away on holiday in August. The previous requirement that this work be done therefore remains All core members are accommodated in single bedrooms, which they have personalised with their own choice of furnishings and fittings and with lots of Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 18 personal items. All bedrooms have a wash hand basin but none have en-suite toilet facilities.. All bedrooms are lockable. There are 2 bathrooms, 1 shower room, and 2 separate toilets provided in the home. All bath and toilet facilities are lockable The kitchen and laundry facilities are appropriate for the needs of the core members and are kept clean and tidy. Other communal accommodation provided includes a large lounge/dining room, a separate television lounge, and a smoking room. There is a cellar that is used mainly for the storage of food but in which there is also a small pool table for the core members use when wanted. There is a garden area and at the time of the inspection clothes were on the line drying in the fresh air, giving a very homely appearance. Each assistant has their own bedroom and these are close to the rooms of the core members. The home is kept clean and hygienic but it was noted that liquid soap and paper towels, although available in most areas, were not provided in all hand wash areas used by assistants. A recommendation has been made that this be rectified. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 36 Core members are protected by the revised recruitment procedures and staff supervision EVIDENCE: This section was not looked at in any depth and will be addressed as part of the next inspection. However the recruitment practices of the home were examined. Care assistant files have been updated as required at the last inspection. 2 written references, and satisfactory CRB and POVA checks are obtained for all new assistants prior to their employment. The application also asks for full employment history and includes a health questionnaire and selfdisclosure. However to fully comply with the revised Schedule 2 a question needs to be added requiring disclosure of registration with any professional body and a recommendation that this be included has been given. Assistants receive regular supervision with the manager and this is properly documented. Assistants on longer-term contracts also receive annual appraisals. Comments from assistants included “Caireen (manager) is very supportive and attentive”, and “the other assistants are very kind and I am very happy here”. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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) 38 Core members benefit from the ethos, and current management and leadership of the home. EVIDENCE: Only one standard from this section was looked at during this inspection. The rest of the standards will be fully addressed at the next inspection. The manager communicates a clear sense of direction and leadership and the ethos of the home is open and transparent. Unfortunately for the home the manager has recently heard that she has achieved a new position within L’Arche. At the present time a new manager for Cana has not been identified. An assistant commented “Caireen (manager) has good leadership – I respect her”. Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x 3 3 3 x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 1 Standard No 31 32 33 34 35 36 Score x x x 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cana Score 2 3 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x x x H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 22 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 17.8 Regulation 13 (5) Requirement A nutritional assessment should be undertaken on each service user (Previous timescale of 31.07.04 extended) Repairs shall be undertaken to the core members bedroom that is showing signs of damage from water ingress, and the wall in the smoking room shall be repaired. (Previous timescale of 30/09/04 not met) Timescale for action 31/12/05 2. 24.12 23 30/09/05 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. 4. Refer to Standard 6.10 18.9 & 18.10 30.1 34.1 Good Practice Recommendations Service users or their representatives sign and date care plans/personal profiles following each six monthly review. All health care professional appointments and there outcomes should be recorded in the core members care plan. Liquid soap and paper towels should be provided at all hand wash facilities that are used by assistants. Recruitment procedures to be further updated to take full account of the Revised Schedule 2 of the Care Standards Act. H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 23 Cana Cana H56-H06 S23371 Cana V227341 220605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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