Inspection on 14/11/07 for Carisbrooke

This inspection was carried out on 14th November 2007.

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

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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 Carisbrooke 341 Peppard Road Emmer Green Caversham Berkshire RG4 8XG Lead Inspector Marie Carvell Unannounced Inspection 14th November 2007 12.45 Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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 Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carisbrooke Address 341 Peppard Road Emmer Green Caversham Berkshire RG4 8XG 01189 462400 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) carisbrooke@choiceltd.co.uk Choice Ltd Mrs Linda Joy Edge Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 5. Date of last inspection First inspection since registration in July 2007. Brief Description of the Service: Carrisbrooke is registered to provide care and accommodation to up to five service users with learning disabilities and complex needs. Due to the physical environment the home would be unable to accommodate service users with complex physical needs. The home is situated in Emmer Green, a short distance from the centre of Caversham and Reading town centre. The home has its own vehicle and there is good access to public transport. The property is detached and accommodation is provided on two floors. The current scale of charges as at November 2007 is between £ 1600.00 and £1800.00 per week. There are additional charges for toiletries, hairdressing, magazines, personal items and outings outside of day care activities. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘baseline Inspection’. The inspector arrived at the service at 12.45am and was in the service until 5.30pm. It was a thorough look at how well the service was doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since registration in July 2007. The inspector asked the views of the people who use the service and other people seen during the inspection. One service user and five members of staff responded to surveys that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. Time was spent with one service user and briefly with the second service user, the manager and staff on duty. A tour of the premises was carried out and a sample of records required to be kept in the home were examined, including the case tracking of the two service user’s files. Feedback was given to the manager at the end of the inspection. What the service does well: Since the home was registered in July 2007, one service user had stayed for a period of respite care and there has been two service users recently admitted to the home permanently. There is a comprehensive referral and admission process in place. Records seen indicated that a full needs assessment was undertaken on the prospective service users’ prior to admission to the home for a trial period. Following a period of settling in supported by home staff, social and health care professionals a meeting took place to decide whether the home was able to meet the service users’ needs. Service user records of the admission and settling in period were comprehensive and well maintained. Both service users have a detailed care plan in place and these are being reviewed and updated on a regular basis as identified needs are being addressed. Service users are involved as much as possible. Daily activities undertaken are recorded in service user’s records. Day care activities are being developed and this is based on the likes and dislikes of each service user. The home has its own transport, which is well used for outings. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 6 From evidence seen by the inspector and discussion with staff on duty, the inspector considers that the home is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. One service user due to a medical condition requires all food to be pureed. Detailed guidelines are in place from a speech and language therapy to assist staff with food preparations and to ensure that the service user is able to have as varied a range of food as is possible. All staff had undertaken training in safeguarding adults from abuse. In discussion with staff all were familiar with the home’s policies and procedures and were clear about the home’s whistle blowing policy. No adult protection investigations have been undertaken since the home’s registration and no referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. Staff on duty were professional in their approach to questions asked by the inspector and were observed to carry out the duties with patience and confidence. It was evident that there is a good rapport between staff and the two service users. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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 Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 4 and 5. Quality in this outcome area is good. Service users are assessed prior to moving into the home and are given the opportunity to visit the home and stay for short periods to be clear whether the home meets their individual needs. Each service user has a statement of terms and conditions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the home was registered in July 2007, one service user had stayed for a period of respite care and there has been two service users recently admitted to the home permanently. There is a comprehensive referral and admission process in place. Records seen indicated that a full needs assessment was undertaken on the prospective service users’ prior to admission to the home for a trial period. Following a period of settling in supported by home staff, social and health care professionals a meeting took place to decide whether the home was able to meet the service users’ needs. Service user records of the admission and settling in period were comprehensive and well maintained. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 9 Each service user has a detailed contract of residency, which is available in appropriate formats. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9. Quality in this outcome area is good. Both service users have detailed care plans and are involved as much as possible, with decision making. Appropriate risk assessments are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both service users have a detailed care plan in place and these are being reviewed and updated on a regular basis as identified needs are being addressed. Service users are involved as much as possible. Service users are assisted and encouraged to exercise their right to make decisions and choices. This is well documented and good interactions between staff and service users were observed during the inspection. Risk assessments are in place to support care plans with guidelines from healthcare professionals, as necessary. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 11 From discussion with staff on duty and observation by the inspector, all staff were able to demonstrate a clear understanding and knowledge of the service users needs and preferred lifestyle. It was evident that there is a good rapport between the service users and staff team. Staff on duty were observed promoting choice and decisions made by service users using a variety of communication methods. Service user records were seen to be well maintained, detailed and up to date. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16 and 17. Quality in this outcome area is good. Service users are assisted to make informed choices regarding all aspects of their daily lives. Service users are able to take part in age, peer and culturally appropriate activities in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily activities undertaken are recorded in service user’s records. Day care activities are being developed and this is based on the likes and dislikes of each service user. The home has its own transport, which is well used for outings. Neither service user is able to communicate verbally, but were able to communicate effectively using facial expressions, gestures and body language. One service user who enjoys sport was able to show the inspector, pictures of Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 13 football games and acknowledged that he enjoyed watching sport on the television. From discussion with the manager and staff on duty, service users are encouraged to maintain regular contact with relatives. Service users rights are respected and this is evidenced in service user’s records. The right to be alone is respected by staff and this is recorded in care plans with appropriate risk assessments, as necessary. Daily routines are relaxed and flexible to meet the service users preferences, this is especially important as both service users are newly admitted to the home. From evidence seen by the inspector and discussion with staff on duty, the inspector considers that the home is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Food stocks were plentiful with fresh fruit, vegetables and salad. One service user due to a medical condition requires all food to be pureed. Detailed guidelines are in place from a speech and language therapy to assist staff with food preparations and to ensure that the service user is able to have as varied a range of food as is possible. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20. Quality in this outcome area is good. The personal and healthcare needs of service users are well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users physical and personal support needs are detailed in care plans. All personal care provided is recorded in daily records. Service user records evidenced that healthcare professionals are in regular contact with one service user who has marked health needs. Guidelines are in place to assist staff to meet the healthcare cares of service users. Records were seen to be well maintained and up to date. Medication storage and medication administration records were seen to be well maintained and up to date with no obvious gaps in recordings. All staff who administer medication have received medication training. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. There is a complaints procedure in a pictorial format for service users. Procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints procedure in place and this is available in a pictorial format, other formats will be available as necessary. There is a complaints log in place and all staff are familiar with the process for recording complaints. No complaints have been received by the home and the Commission has received no information regarding complaints about this service since the home’s registration in July 2007. All staff had undertaken training in safeguarding adults from abuse. In discussion with staff all were familiar with the home’s policies and procedures and were clear about the home’s whistle blowing policy. No adult protection investigations have been undertaken since the home’s registration and no referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 16 Policies and procedures are in place for dealing with service user’s monies and bank accounts. Both service users depend on the manager and key worker to manage their personal allowance on their behalf. Clear, well maintained and up to date records are kept for each service user’s finances. Financial records will be audited on an annual basis. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,27,28 and 30. Quality in this outcome area is good. Service users live in a homely, clean and safe environment, which meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is newly registered and has been refurbished to a high standard. The staff team have worked hard to ensure that the home is comfortable and welcoming. Requirements made by the Fire Authority and Environmental Health has been complied with. All radiators are covered to reduce the risk of burning to service user and thermostatic devices are fitted to all hot water outlets. All five bedrooms are for single occupancy and have en-suite shower rooms. Two bedrooms were visited at the invitation of the service user. Both Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 18 bedrooms reflected the interests of the service user and were comfortably furnished. There is one communal bathroom with toilet and a second toilet accessible for wheelchair users. Appropriate aids and adaptations are in place to assist with safe bathing following advice from an occupational therapist. This will be ongoing as service users are admitted to the remaining three places. The home although not purpose built is spacious. Communal areas consist of a large, bright lounge, a separate dining room and a small conservatory. There is a secure garden to the rear of the premises and a wooden building, which is to be developed into an activity room. The home was found to be clean, fresh and hygienic. Daily cleaning schedules are in place and senior staff monitors these. The home has a laundry room and although the area is compact is well equipped. The washing machine has a sluicing facility. Policies and procedures are in place regarding infection control measures and staff have received health and safety training. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,34,35 and 36. Quality in this outcome area is good. Service users benefit from an experienced staff team in sufficient numbers to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff on duty were clear about their roles and responsibilities in the home. Most of the staff in post have had previous experience in caring for adults with learning disabilities and or behaviours that challenge the service. There are currently ten full time and three part time staff in post. The manager is currently recruiting to the four support staff vacancies. Staff on duty were professional in their approach to questions asked by the inspector and were observed to carry out the duties with patience and confidence. It was evident that there is a good rapport between staff and the two service users. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 20 Training is promoted and there is a staffing training and development programme in place. This includes mandatory as well as specialist training. Currently five support workers have achieved National Vocational Training at level II or above. Surveys completed by support staff confirmed that all staff have received training relevant to their role. One survey stated that the training was ‘well organised’ Service users are protected by the organisations recruitment procedures and the organisation has a formal agreement with the Commission to hold staff recruitment documentation centrally, with a signed checklist being completed and signed, kept in the home. A sample of staff personnel file were examined and found to be maintained inconsistently. Some files contained written references and application forms, whilst other contained a copy of the Annexe four form signed and dated, but with no information recorded as to when an application form was completed, whether references had been received or if appropriate police checks had been undertaken. The manager was able to show the inspector evidence of police checks being completed prior to employment and has agreed to audit all staff files to ensure that all annexe four documents are completed fully. Staffing levels reflect the needs of the service users and rosters are flexible to fit around their lifestyle. On the day of the inspection in addition to the manager on duty were a senior support worker and support worker working from 7.15 am until 2.45pm with an additional support worker working from 9.30am until 5pm. Two senior support workers were rostered to work from 2.15pm until 9.45pm and two staff working during the night from 9.30pm until 7.30am the following morning. Staffing levels will be reviewed as the needs of the service user are identified. Handovers between staff are conducted at the beginning of each shift and since the home’s registration one staff meeting has taken place. Communication systems are well organised in the home. In discussion with staff on duty and from comments made on staff surveys, staff feel supported. Comments made included ‘On a daily basis, we discuss not how I am working, but how the house runs and other staff concerns’, ‘ managers always give their time and support when you need it’. All staff receive formal, planned supervision. A written record is completed and includes action to be taken. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39,40 and 42. Quality in this outcome area is good. Service users benefit from a well managed service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An experienced and well qualified registered manager has been in post since the home’s registration. It is evident that the manager is well respected by staff, relatives and colleagues. Relatives have expressed their satisfaction about the management of the home. Staff described the manager as fair, approachable and a good listener. Staff also felt that the manager would not tolerate poor practice. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 22 Policies and procedures are in place and are reviewed on a regular basis, in line with organisational procedures. All records seen during the inspection were up to date and well maintained. Reports are written on a monthly basis, following a visit to the home by a provider representative. A sample of the reports were examined and found to be detailed and up to date. Records in relation to health, safety, fire and service user welfare were in place, well maintained and up to date. Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 23 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 3 5 3 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 3 25 3 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 2 35 3 36 3 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 3 x 3 3 x 3 x Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 24 N/A 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. Refer to Standard Good Practice Recommendations Carisbrooke DS0000069623.V353026.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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