CARE HOME ADULTS 18-65
Cherry House 3 Draycot Road Surbiton Surrey KT6 7BL Lead Inspector
Claire Taylor Unannounced Inspection 11th October 2005 3.30pm Cherry House DS0000013411.V253301.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 Cherry House DS0000013411.V253301.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. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cherry House Address 3 Draycot Road Surbiton Surrey KT6 7BL 020 8390 5750 020 8287 1950 richard@maplelodge.charityday.co.uk 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) Mental Aid Projects Mr Richard Weir Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Mental Aid Projects is a charitable organization providing residential and day care services. The organization currently offers residential care in three small homes in Surbiton. One of the aims of this is being that varying degrees of support and independent living can be offered. A Registered Manager oversees all of the homes; however there is a designated House Leader based who is based at Cherry House. The day-to-day running of the home is mainly the responsibility of the House Leader. There is a strong network of support and friendship amongst service users in the different homes. Cherry House provides accommodation for three adults who have a learning disability. Staffing is provided throughout the waking day. A staff member sleeps at the home at night and is available as required. All service users are assigned a key worker, who supports them to plan activities and day programmes. They also provide an opportunity for service users to have a named person to discuss any issues, concerns or plans. Service users are supported to make use of local day services and colleges. Support with these and travel in the community is agreed on an individual basis. At the home, service users are supported to learn and develop domestic skills and are involved in house hold tasks. Service users are also encouraged to make use of the local community. Mental Aid Projects offers a number of recreational services, which the service users are able to join if they wish to. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over late afternoon / early evening and lasted four and a half hours. All three service users met were willing to share their experiences about life at the home and their help with this inspection is very much appreciated. Other time was spent examining records, and talking with the house leader on duty and the registered manager who arrived at the home towards the end of the inspection. Two relatives were also visiting at the start and are thanked for their comments. A walk round the premises took place and two service users showed the inspector their bedrooms for which they are thanked for taking the time to do so. Standards relating to staffing were not assessed on this occasion due to the majority of records being held centrally by the owning organisation. These will be assessed at the next inspection. What the service does well:
This home provides good support for service users to live as independently as possible and improve their quality of life. Due to its small size and good staffing ratio, the service users benefit from a family type environment. They are encouraged to take responsibility for running their home and learn, or further develop independent living skills such as cooking, domestic tasks and organising their personal leisure activities. The design of this family type home and the small number of service users allows for a great deal of freedom of choice. Service users are treated with respect as individuals, offered choices and are encouraged to make their own decisions and follow their interests and hobbies. Activities are varied and are chosen by service users. There are good opportunities for service users to maintain contact with their families and friends. All three service users commented favourably about their lifestyle in the home and stated they felt well supported by the staff. Planning and review of care for the service users is thorough and well organised. The owning organisation’s move towards person centred planning is seen as good practice as this is a more service user focused way of meeting their needs. The premises are kept in very good decorative order, homely and generally well maintained to maximise safety for the people who live and work in the home. Service users bedrooms reflect their individual preferences and contain their personal possessions. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 6 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.
Cherry House DS0000013411.V253301.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 Cherry House DS0000013411.V253301.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): 2 and 3 Detailed assessments are completed to ensure that the home can meet the needs of prospective service users. A minor variation in registration category is needed to acknowledge that the home can continue to meet the needs of one service user who is over the age of 65 years. EVIDENCE: There have been no new admissions to Cherry House since the last inspection (March 2005). The home ‘s needs assessment plan is detailed and covers all areas to ensure that any new service user’s needs are fully assessed prior to their admission. A specific form is used on which to record an overall assessment of each service user once they have been admitted. This covers all aspects of the person’s life, including strengths, social and cultural needs and psychological needs. Copies of these assessments were on file for each service user as well as detailed needs assessments completed by their placing authorities. I.e. undertaken by their care managers. One of the service users is over the age of 65 and the home is currently registered to accommodate younger adults with learning disabilities who are between the age of 18 and 65 years. The registered provider is therefore required to submit a variance application to ensure that the service user is acknowledged in the home’s registration category and demonstrate that the home can continue to meet their needs. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 9 Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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 the following standard(s): 6,7 and 9 Service users’ plans of care clearly identify their needs and how they are supported to achieve their planned goals. Individual plans are frequently reviewed and reflect any changing needs. Choice and decision making for service users is promoted to a good standard enabling their involvement and opportunities to contribute to the operation of the home. To enhance the service users independence, effective support is provided within a risk management framework although some individual plans need reviewing to fully safeguard individuals from potential harm. EVIDENCE: Each service user has an individual service user plan that appeared informative and well organised. These plans tell the staff about the best ways to support each person who lives in the home. They also detail what each service user likes to do each day, the things that they like and how the staff should do best support them to achieve their personal goals. Records showed that service users plans were being reviewed every six months to reflect any changing needs or goals. Examples of achieved goals as well as planned ones were documented. They included one service user being supported to attend a gardening course and another service user being supported to go swimming as
Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 11 she so chose. Service users spoken to described how staff take a personal interest in their development and achievement, and that they were encouraged to achieve their personal goals. In addition to plans of care, guidelines have been developed to give greater depth of information on specific needs e.g. “anger management” for one service user. One service user has a pictorial timetable displayed in their room to ensure that choice of activities is promoted and that structure and routine can be better established for them. The registered manager advised that the organisation intends to develop plans of care that are based on Person Centred Planning principles. Such planning centres on the needs of the service user and not the service. It is envisaged that PCPs will be completed within the next six months. Service users meetings are regularly held and discussions are geared towards their views. The service users all get involved in things like choosing what food to eat and arranging their preferred social and leisure activities. The house leader appeared committed to ensure that service users are fully involved with the operation of the home and encourage them to contribute. The people who live at Cherry House are very independent and do not often need staff to help them to go out or to do the things that they want to do. Relevant risk assessments, matched to individual needs were in place for all the service users but some improvements are required. A risk assessment tells the people that support the service user if there are activities that a person undertakes, or things that might happen, that put them at risk of being harmed. E.g. use of the kitchen, accessing the home / wider community, use of hot water, self-medication, social behaviour and for occasional times when service users are left alone in the home. Some risk plans are now in need of review however in relation to visitors coming to the home when the house is temporarily unstaffed. On arrival for this inspection, the inspector met one service user on their return from work at the door and was invited into the house. The other two service users introduced themselves and two relatives were also visiting at this time. One service user explained that the staff had gone to the bank to withdraw petty cash money for the house. The home has a policy that visitors should not enter the home without a member of staff being present and both relatives confirmed this. Although it was reported that this was an unusual occurrence, further work is therefore needed to maximise service users personal safety and protect their vulnerability. The house leader and registered manager acknowledged this. A further requirement set is that risk assessments need to be expanded upon and developed to reflect their individual assessed needs and lifestyles. Each risk assessment must specify the risk; possible consequences of the risk; and action required to minimise it. A missing person’s policy is in place which gives staff clear guidance if a service user was to go missing. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 15, 16 and 17 Service users are supported to continue education and appropriate activities within both the home and local community, so that they can maximise fulfilment and achievement in their lives. The daily routines and house rules promote service users’ rights and encourage independence. Appropriate contact between service users and their families and friends is encouraged to help them maintain relationships. Food provided represents a range of nutritional and cultural preferences to ensure that service users choices are met and a healthy diet is promoted. EVIDENCE: Cherry House supports a person living there to engage in appropriate activities of their choice and the local community is well used by service users. The three service users at the house have a range of structured activities. One service user is retired and attends a local day centre for four days a week. She gave very positive views about the centre and said that there were lots of things to do there. Educational and employment needs are assessed at annual reviews and appropriate day programmes have been established to meet these needs. Records within the care plans reflected this. The home informs service users about activities through regular meetings, informal discussions and the use of
Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 13 a notice board. Service users have the freedom to come and go as they wish and are offered keys to their own bedroom and the front door. Records showed that service users often engage with friends outside of the home as well as friends and colleagues being welcomed to Cherry House. Relatives can visit regularly and two family members were visiting the home at the start of the inspection. They both confirmed that they were always made to feel welcome and that they were happy with the good standards of care provided for their relative. Service users confirmed that they are asked to choose the meals they want to eat and shop for their selected foods. The menu option is displayed in the kitchen and if not desired on the day, alternatives are provided as service users wish. Service users had their evening meal during this inspection and one service user assisted throughout the meal preparation with appropriate support from the house leader. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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 the following standard(s): 18 and 19 Promotion of health is well observed. Service users welfare is closely monitored and suitable arrangements are in place to ensure that their physical and emotional needs are met. EVIDENCE: The current service users at the home are very independent and require little or no assistance with personal care (e.g. washing/bathing, dressing/undressing and eating meals). Detailed guidelines on any support with personal care are recorded within the individual plans. The home supports service users to be flexible about when they choose to get up, go to bed, have a bath, and eat. Service users are encouraged to contribute to household management duties including cleaning, shopping and cooking. Their assigned tasks and responsibilities are all clearly defined within their care plans. Records concerning healthcare needs were in very good order. They showed that potential complications and problems are identified and dealt with through prompt referrals to the appropriate health professional. E.g. regular blood pressure checks for one person. Service users are registered with a local GP practice and have access to other NHS facilities as necessary. E.g. dentist, optician, chiropodist, and a “well woman” clinic. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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 Although the home has a complaints procedure, improvements are needed to ensure that service users, their relatives and other parties are fully aware of the process and that their views/ concerns will be listened to and acted upon. EVIDENCE: Staff encourage and support service users to discuss any concerns or worries either through home meetings or on a one to one basis. Records reflect such discussions and staff members talked respectfully and sensitively with the service users. There had been no complaints recorded since the last inspection. There is a complaints policy on the wall that includes photographs to facilitate its use for service users although improvements are needed to ensure that full information on how to make a complaint is available. It was not clear if service users were fully aware of the process to follow if they were unhappy. The home is therefore required to amend the procedure and ensure that all service users, relatives and other parties are fully informed about how to make a complaint. Details on how to complain to the CSCI must be included in the procedure. The home has adopted the Royal Borough of Kingston’s Suspected Abuse of Vulnerable Adults Joint Policy and also has an additional policy on protection of vulnerable adults and whistle blowing. The registered manager stated that staff are provided with training on abuse awareness and the protection of vulnerable adults. Staff records were not accessible on this occasion and will be looked at during the next inspection. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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 and 30 Cherry House is homely and comfortable and promotes a family-like atmosphere that further enhances the service users emotional well-being. Bedrooms are designed and furnished to meet the personal preferences and individual lifestyles of the service users. The home is kept clean, hygienic and in a generally good state of repair although the bathroom is need of some minor repairs. EVIDENCE: The home is a semi-detached property situated in Surbiton and well placed for access to local transport links and amenities. The neighbouring house, Oak House, is also owned and managed by Mental Aid Projects. The gardens at the home are interconnecting, however service users are asked to respect each other’s privacy and must not use the connecting gate to enter the other home without first being invited. As required at the last inspection, some redecoration work has been completed including necessary repairs to plasterwork and the bathroom has been repainted. The layout of this family type house appears to suit the personal and lifestyle needs of the service users who live there. Two service users showed the inspector their bedrooms and commented that they were happy with them. Bedrooms seen are highly personalised to reflect the service users individual personalities and lifestyles. The service users manage their own laundry and use the washing machine
Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 17 independently. The home was clean, tidy and generally in a good state of repair although the sealant around the bath should be replaced. A written plan for the home’s overall maintenance and redecoration programme needs to be put in place to fully meet the standard. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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): X Standards not assessed at this inspection. EVIDENCE: These standards were not assessed on this occasion as staff records were not available. The owning organisation, Mental Aid projects keep staff files centrally in their main office. The standards were however all assessed as met at the last inspection and the reader is referred to the last report (2 March 2005) for details. The staffing standards will be assessed during the course of the home’s next inspection. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 19 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): 39 and 42 Improvements are needed with quality assurance systems to ensure that the quality of care is regularly appraised and changes can be made. The development and introduction of systems that record the views of residents and relatives should increase confidence that their views influence the running of the home. Overall the homes health and safety arrangements are adequate to protect the service users and staff from avoidable harm although the hot water supply must be adjusted to the required temperature. EVIDENCE: The home does have some systems in place that serve as a means of quality monitoring such as regular review meetings for service users and monthly environmental audits. At the previous inspection, the home was required to implement a formal quality assurance system and an annual development plan, with both involving service users. As this has not commenced, the requirement remains in force. Satisfaction questionnaires need to be offered to service users, their relatives and other interested parties. Once these are Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 20 returned this information should be included in the annual development plan. This then can be used as the basis of a quality assurance system. The home has a health and safety file in place and the manager completes a health and safety check on the environment every month. Risk assessments covering safe working practices for the premises have been completed. Fire drills, fire equipment and fire system checks are carried out at appropriate intervals. There were valid up to date certificates for electrical and gas safety. Other documented checks include hot water temperatures, first aid supplies and food storage and cooking temperatures. Records revealed that the hot water was running at a temperature of 49 degrees Celsius and this exceeds the recommended safe limit of 43. Risk assessments were in place however concerning the service users safety. The registered manager reported that work was due to be carried out within the forthcoming week due to an immediate requirement being set for the neighbouring Oak house concerning their hot water supply. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 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 X 3 2 X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Cherry House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000013411.V253301.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes- 1 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 YA3 Regulation 12(1)(a) Requirement Timescale for action 30/11/05 2. YA9 3. YA9 4. YA22 5. YA24 The registered provider is required to submit an application for a variance in category of registration for the service user who is over the age of 65 years. 12, 13(4) Service users risk plans need to be expanded upon in more detail to identify clearly what measures are in place to minimise incidences of risk. 12, 13(4) Risk assessments must be reviewed to maximise service users personal safety when the home is left unstaffed. 22 The home must amend the complaints procedure and ensure that all service users, relatives and other parties are fully informed about how to make a complaint. Details on how to complain to the CSCI must be included in the procedure. 23(2)(b)(d) The registered manager must develop and maintain a written plan for the home’s overall maintenance and redecoration programme. 31/12/05 30/11/05 31/12/05 31/12/05 Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 23 6. YA39 24 7. YA42 23(2)(j) The registered provider must ensure that a quality assurance programme is implemented within the home to record the views of service users and their families. (Timescale of 30/06/05 not met) The registered provider must ensure that the hot water supply for hand basins, baths and showers for the use of service users is maintained at a temperature of 43 degrees Celsius. 31/01/06 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA30 Good Practice Recommendations The sealant around the bath should be replaced. Cherry House DS0000013411.V253301.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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