Inspection on 14/08/07 for Clearview

This inspection was carried out on 14th August 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Clearview 07/09/06

Clearview 17/01/06

Clearview 12/09/05

Clearview 18/01/05

Clearview 25/08/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Clearview 48 Lipson Road Lipson Plymouth Devon PL4 8RG Lead Inspector Helen Tworkowski Unannounced Inspection 14th August 2007 1.15pm Clearview DS0000003465.V343321.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 Clearview DS0000003465.V343321.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. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clearview Address 48 Lipson Road Lipson Plymouth Devon PL4 8RG 01752 256980 NONE clearviewpl4@btopenworld.com 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) Mr Jeffery John Nicholson Mrs Amanda Jane Nicholson Mrs Amanda Jane Nicholson Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7), Physical disability (7), of places Physical disability over 65 years of age (7) Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Learning disabled adults some of whom may have a physical disability Date of last inspection 7th September 2006 Brief Description of the Service: Clearview is a home that currently accommodates six people with varying degrees of Learning Disability and Challenging Behaviours. The service users have complex care needs and require a high level of support. Mr Jeffery Nicholson and Mrs Amanda Nicholson own the home. Mrs Nicholson is also the Registered Manager. Clearview is situated in the Lipson area of Plymouth within easy access to local amenities, including shops and parks. The home is a large terraced property, which has a large lounge, adjoining dining room and domestic style kitchen and utility room. Service users are accommodated in single bedrooms, three with en-suite facilities. There is a patio area at the rear of the premises. Service users are supported to take part in a range of opportunities inside and outside the home. The manager said that the fees at Clearview vary according to each person’s needs and level of support, currently fees range between £500 and £1500. The fee does not include: transport, hairdressing, chiropody, toiletries, holiday spending and tobacco. The home has a Service User Guide and a Statement of Purpose, which provide information about what is provided at Clearview. These documents are available in the office, and each Service User has a copy of the information in a form that is suited to their needs. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included unannounced site visits to Clearview on 14th August 07 (1.15pm to 5.15pm) and on 15th August 07 (12.00-4.15pm). During these visits the Inspector looked around the building, talked with five of the staff and the manager, looked at the medication system, records relating to the people who lived in the home, in relation to staffing and in relation to the general management of the home. The Inspector spent time talking with service users and looked at the care and support provided to two people in more detail. As part of this inspection the inspector ate lunch with one person. Survey forms were sent to the service users however these were not received back. Survey forms were also sent to all of the staff, three were returned at time of the inspection. In addition Mrs Nicholson the Registered Manager completed an “Annual Quality Assurance Assessment” form. This provided information about how the manager considered the home had improved in the last year. In addition the Inspector telephoned and spoke with one Social Worker from Social Services and with a person who provides support in relation to challenging behaviours. What the service does well: Clearview is a well-managed service providing a good standard of accommodation to people with a learning disability who may challenge services. Service Users are well supported by staff, who enjoy their work, and the homely atmosphere at Clearview. Staff are well trained and there are good systems for recruiting staff. Such systems help ensure that service users are protected from abuse. One person from Social Services said that they supported people with challenging behaviour extremely well. Another person said that the staff at Clearview had a good understanding of what Service Users and what they like to do. The people who live at Clearview are able to lead active lives participating in a range of activities both inside and outside the home. Service Users observed or spoken with felt that were treated well by staff. Service Users can choose what they eat and are able to make choices about how they spend their time. They are give the support they need to help them dress in a way that suits them. The house is well decorated and homely. Service Users treated the house as if it was there home, for example they went into the kitchen to help with the dishes and to see what was being cooked for tea. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Clearview DS0000003465.V343321.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 Clearview DS0000003465.V343321.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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users can be confident that their needs will be known prior to a move to the home and they will be given clear information about what they can expect at Clearview. EVIDENCE: No new people have moved to Clearview since the last inspection almost a year ago. When the last person moved to the Clearview the person’s needs were well known and staff had received additional training. The person had had the opportunity to visit prior to a move. We were told that when a person moved to the home then they are given a Service User Guide that has been specifically designed to reflect their abilities, for example with photographs and symbols. In addition relatives are given a written copy of the document. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users needs are known to staff who provide a good level of support. EVIDENCE: The Service User Plans for two people who live at Clearview were looked at in detail during this inspection. These documents should explain in detail how the needs of each person are to be met. This is particularly important if a Service User has complex needs, which some of the people at Clearview have. The Service User plans were up to date, and had recently been reviewed. The documents each contained information about how needs were to be met. There was detailed information about how staff should identify when a service user is becoming agitated or upset and there was guidance on the actions that staff are to take. One of the Plans clearly identified the conditions that a Service User had, but also went on to identify how this affected the individual and the support that they needed. Service User Plans also contained information about how the individual’s finances were being managed. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 10 The Inspector spoke with a professional who has worked with the staff and provided help and guidance in relation to one Service Users challenging behaviour. She said that staff had followed the guidance given, had asked for help when they needed it and as a consequence the individual had settled well at Clearview. She said that they had supported the individual extremely well. Some of the Service Users have restrictions placed on them, for example the front door is alarmed so that they are not able to leave the house without staff being aware. These restrictions have now been noted in the care plan, having first been discussed at a multidisciplinary meeting. We discussed with staff the need to be aware of and to implement the new Mental Capacity Act. This act provides a framework for making decisions, in the best interests of people who are unable to do so for themselves, including decisions that restrict individuals. It also provides legal protection for those who must place such restrictions on others. Each person had a set of risk assessments that identified the sort of risks that they might be exposed to, and how these risks could be managed and minimised. Health Action Plans had been completed for three of the people living at Clearview. These documents help identify what health issues a person has and the help and support they need, as well as providing easily readable information. It was noted that in this Inspection Service Users were asked about how they wanted to spend their time- they were given choices. One of the staff commented to the Inspector that she felt that there was no hurry to get people up; they could get up in their own time. The Manager, Mrs Nicholson confirmed this. One of the staff completing the staff survey commented “I feel that Clearview provides an excellent standard of support and care to all our service users”. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users received a good level of support and are encouraged to participate in a range of activities at home and in the community. EVIDENCE: The Inspector spent time sitting and talking with Service Users about their lives at Clearview, and ate lunch with one of the Service Users. We were told that Service Users help choose some of the meals on the menu. Service Users spoken with were clear what food they liked, and the menu showed that people took it in turns to choose the main meal of the day. One of the Service Users had made some scones earlier on the morning of the first visits. All Service Users took a healthy interest in what was happening in the kitchen, including helping with the dishes. There was a bowl of fresh fruit in the kitchen; the Inspector was told that Service Users are involved in the shopping. The Inspector spoke with one member of staff about the quality of food, she said that the staff ate the same food, which was a good indicator that the food was Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 12 of a good quality. She also said that there was choice, if people wanted something then they could have it. Service Users no longer have access to Plymouth Social Services day services, and staff at Clearview are involved in finding activities that suit service users’ interests and hobbies. Each person has an activity plan for the week, the Inspector discussed with staff how one person had very limited occupation. Staff were able to show the Inspector how they were reviewing each person’s activities and had found new things for individuals to do. On the first day of the inspection, one person was out visiting a relative, one person was out with a member of staff, and the other four people were at home. On the second day of the inspection five of the service users were out with staff, whilst one person had chosen to remain at home. The Inspector spoke with a Social Services employee about the how the people at Clearview spent their time. He explained he had been involved in helping staff to look for activities. He had found that the staff were positive and had a good understanding of each person’s needs, also of their personality and the sort of things that might be successful. One member of staff commented that he/she thought that one of the things that the home does well is “One to one time out with Service users and a few times a week joint trips as well”. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are provided with a good level of support to meet their health and personal support needs, including where Service Users have challenging behaviour. EVIDENCE: Staff at Clearview are now using a monitored dose system to manage medication. This system is prepared in bubble packs by the pharmacist. Staff said that they had training from the pharmacist in the system and were confident in its use. There were records of medication being administered and where it had not been required it had been returned to the pharmacist. Where Service Users needed “as required” medication there was clear guidance on the when it should be given. As already been identified earlier in this report, health action plans are being developed for each person. These identify each person’s health needs and record any contacts with health professionals. The information on file showed that where people had had health issues that advice had been sought. During this inspection it was noted that all of the Service Users were well dressed in styles that suited the individual. Clothes were well pressed and Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 14 clean, and when stained were changed. Service Users hair was well cut and time and trouble had been taken to ensure that they were smart. Clearview DS0000003465.V343321.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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users and their representatives are able to raise concerns about the service, if they should wish to do so. There are good systems in place for protecting Service Users from abuse, and to help manage their finances. EVIDENCE: Clearview has a complaints procedure that has been provided in a symbol format, this is included in each Service User Guide. Each individual has a copy of this document. The deputy manager said that this is also given to their relative. No complaints have been received by the Commission and the Inspector was told that no complaints had been received by Clearview, since the last inspection. There is a record of staff training that shows that all staff have received training in relation to the protection of vulnerable adults. The three member of staff who returned staff survey forms all said that they were aware of adult protection procedures. The quality assurance form completed by the manager shows one of the ways that the home is monitoring concerns or issues is through questionnaires completed by relatives, and these have all been positive. The systems for managing Service Users money has now been changed. All Service Users money is paid into each person’s own account. Where Clearview Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 16 makes a charge, for example for accommodation, then the money can be seen leaving the account. This is important, as there must be a clear separation between the running of the business and the service users own personal finances. There is also information about how service users finances are managed in the Service User Plan. Clearview DS0000003465.V343321.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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users benefit from a clean, comfortable and homely accommodation. EVIDENCE: This inspection was unannounced, the house was found to be clean and in good order. The hallway has been decorated since the last inspection and is now of a similar high standard to the rest of the house. The dining room and sitting room are large, airy and domestic in character. Service Users bedrooms have been decorated to reflect their tastes and preferences. The inspector tested the hot water in the ensuite showers. The water in the shower could be adjusted so that it was sufficiently hot to scald. It is the expectation of the Commission that under such circumstances that the hot water is risk assessed, and if deemed necessary thermostatic control valves fitted. No risk assessment had been made, however other taps in the building had been fitted with thermostatic valves. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 18 The Manager said that they had recently received a visit from the Environmental Health Officer and that they were now adapting their systems to fit in with the new guidance on how to ensure that the home is safe. Clearview DS0000003465.V343321.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): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to ensure that the right staff are recruited. Staff are well trained and supported, and there are sufficient staff to enable service users to live active lives. EVIDENCE: One new member of staff has been recruited to work at Clearview since the last inspection. The recruitment records were looked at. These showed that proper checks had been made before the person had been employed. This had included seeking two references, and carrying out a check of the criminal records and suitability to work with vulnerable people. The individual had received an induction, and there was a record of training and supervision received. The three staff who responded to the staff survey all said that they were not asked to care for people who are outside their area of expertise, and that they had support to do their job well. One person commented “Clearview is a relaxed home, staff and service users have a good relationship. It is like having a second “family” and an enjoyable atmosphere to work in. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 20 There were three staff on duty on each of the days of the inspection; this was sufficient to allow service users to be able to go out and about either individually or in a group. The annual quality assurance form completed by the manager noted that there had been an increase in the level of staff. Two of the staff have started their “learning disability awards framework” level 3 training. The inspector was told that this was useful as the training was focused on working with people with a learning disability. Clearview DS0000003465.V343321.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): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users benefit from a well managed home. EVIDENCE: Mrs Nicholson is the joint Registered Provider and the Registered Manager for Clearview. Mrs Nicholson has completed the Registered Mangers Award, has a nursing qualification and many years experience in working with people with a Learning Disability. All three of the staff who responded to the survey said that they felt well supported in their work, and this was confirmed in discussion. One staff noted where there had been difficulties this had been discussed. There are regular service user meetings where individuals are able to discuss their views about what happens at Clearview. Staff also have regular meetings. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 22 We were shown a health and safety check that is carried out by staff each month. This check is to ensure that that the home is safe. There was a further annual safety check carried out by an external organisation. This identified where there were any shortcomings in the organisation in relation to health and safety and made recommendations. The document identified some shortcomings, some of which had been dealt with others that had not: principally no risk assessment in relation to Legionella had been carried out. We looked at the fire risk assessment and the fire logbook, to confirm that regular checks on fire safety were being made. As has already been noted the hot water in showers has not been risk assessed in relation to the risk of scalds. Clearview DS0000003465.V343321.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 x Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 13(4)a Requirement Risk assessments in relation to hot water in showers must be completed and implemented, to ensure that the risk of a person being scalded is managed. Timescale for action 01/12/07 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 YA18 Good Practice Recommendations The manager and staff should ensure that they are familiar with the Mental Capacity Act and implement as appropriate. Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Clearview DS0000003465.V343321.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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