Inspection on 17/01/06 for Clearview

This inspection was carried out on 17th January 2006.

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 14/08/07

Clearview 07/09/06

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 Wendy Baines Unannounced Inspection 17th January 2006 10:00 Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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.V263050.R01.S.doc Version 5.1 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.V263050.R01.S.doc Version 5.1 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.V263050.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Learning disabled adults some of whom may have a physical disability Date of last inspection 12th September 2005 Brief Description of the Service: Clearview is a home which 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. The home is owned by Mr Jeffery Nicholson and Mrs Amanda Nicholson. Mrs Nicholson is also the Registered Manager. Clearview is situated in the Lipson area of Plymouth within easy access to local amaenities, 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 accomodated in single bedrooms, three with en-suite facilities. There is a patio area at the rear of the premises. Service users are supported partake in a range of opportunities inside and outside the home. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place on the 17th January 2006, between 9.30 and 2.30. A Pre-inspection questionnaire had been returned to CSCI prior to the inspection and included up to date information regarding the residents, staff and other details about the home. Service user and relative questionnaires had also been returned and included positive feedback regarding the service. One relative commented that they were not aware of the homes complaints procedure and this was fed back to a senior member of staff. The Registered manager was not working on the day of the inspection, however the assistant manager was available throughout the day. The Inspector was able to spend time with the residents who were at home and meet with the staff on duty. A sample of residents and staff records were seen as were records relating to the home, including Health and Safety checks, accident and incident reports and risk assessments. The atmosphere of the home was warm and welcoming. What the service does well: The home provides current and prospective service users with good information about the home and services provided. A Pre-admission assessment is completed to establish if the home can meet the needs and visits to the home are arranged whenever possible. Each service user has a written care plan, which details their skills and this information is regularly reviewed. Service users are supported to partake in a range of planned and leisure activities and the Registered Manager liaises regularly with outside agencies to ensure that these arrangements sufficiently meet the needs of each individual. Staff have a good understanding of the communication methods of each individual and use this knowledge to ensure that service users are able to make choices, and express any concerns regarding the home and their care. The Registered Manager and staff have a good understanding of the changing needs of service users due to age, health and/or illness. Consideration is given to the environment and training needs of staff to ensure that these changing needs continue to be met. The home has good systems and procedures in place for monitoring service users health and any changes are dealt with promptly. The home recognises the importance of contact with family and friends and works hard to support and maintain these arrangements. Service users and staff are supported by a open, inclusive and positive style of management. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home should continue to develop the care –planning process by ensuring they are sufficient in detail to identify specifically how needs will be met. Consideration should be given to Person Centred Planning to ensure a more holistic approach and longer term outlook, with a view to further enhancing or supporting the opportunity for more fulfilling lives. The home should explore opportunities for Advocacy input to support service users to make choices and cope with changes to their care and services provided. The home should ensure that any arrangements for the use of baby monitors or other similar facility is documented and reviewed. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 7 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. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 8 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.V263050.R01.S.doc Version 5.1 Page 9 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): 1,2,3,4. Current and prospective service users are provided with sufficient information to make an informed choice about where they live and the support they receive. Staff regularly undertake relevant training to ensure they have the skills to meet current and changing needs. EVIDENCE: The Statement of Purpose and Service user guide were available. Current Service users had a copy of this information, which included pictures, and symbols detailing information about the home and the services provided. The manager said that there had been no new recent admissions to the home but was able to give a clear account of the homes admission process, which included a Pre-admission assessment and visits when appropriate. Each current service user had a written care plan and it was evident through discussion and records that staff regularly update their training to ensure that changing needs continue to be met. Two members of staff had arranged to undertake a training course relating to Diabetes, and the District Nurse had visited to offer advice and guidance to all staff working in the home. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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): 6,7,8,9. Service users are encouraged and supported to make decisions and choices regarding day- to -day life in the home. Service user plans include information regarding daily living skills but do not identify long- term goals and individual wishes. EVIDENCE: A sample of Service user plans were seen during the inspection. This information included details of each individuals’ daily living skills. Discussion took place with the assistant manager for the need to ensure that care plans are sufficient in detail to identify how needs will be met and should include any specific guidelines for staff. Service user plans did not include details of service user skills relating to finance and the support required. Staff had undertaken some training relating to Person Centred Planning. Consideration should be given to incorporating this approach into the homes care planning system to ensure a more holistic and longer term outlook, with a view to enhancing or supporting the opportunity for more fulfilling lives. The home had liaised with the Specialist Learning Disability Service regarding behaviour Management and files contained individual risk assessments and Behaviour Management guidelines. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 11 Service users are supported and encouraged to make choices about their plans for the day and where possible can assist with chores and activities around the home. One member of staff is responsible for coordinating service user meetings and questionnaires. Consideration was being given to developing these opportunities to ensure that everyone can be involved and have their views listened to. Staff demonstrated a good understanding of service users individual communication methods and were able to support and encourage them to make choices and partake in the daily routine. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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): 11,12,13,14,15,16. Service users are encouraged and supported to maintain and learn life skills, and participate in a range of social/leisure activities. The home recognises the need for service users to maintain contact with family and friends and considerable efforts are made to support these arrangements. EVIDENCE: Individual weekly planners included information of planned activities and opportunities for free time and leisure. All service users require support to access opportunities away from the home setting and the level of support required is documented within care plans and risk assessments. Service users are supported to attend day centres, and other regular weekly activities as well as a range of social opportunities in and around the local community. The weekly staff rota is planned dependent on these arrangements. On the day of the inspection service users were concerned about possible changes to their day- care arrangements. It was evident that the staff had not been informed of any definite changes and were working hard to support service users at this difficult time. All the staff were very aware of how these Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 13 changes may effect the well being of individuals and were liaising closely with Social Services to ensure the needs of each individual is considered. Discussion took place with the Assistant manager regarding the need to explore Advocacy Services and to develop Person Centred Planning to ensure that long term needs and individual wishes are explored. Service users are encouraged and supported to maintain links with family and friends. Communication books have been developed for some service users with limited verbal communication and these are passed between the home and the family to ensure consistency of care. Service users were keen to tell me about their Christmas holidays and regular visits home. Service users privacy is respected as far as is feasible within the limits of the assessed risk. Baby monitors have at times been used when service users have been unwell. Discussion took place with the assistant manager that this facility should not be used as every day practice but only as part of a multi-agency agreement and reviewed regularly. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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): Service users healthcare needs are monitored and any changes are addressed as soon as they are identified. Staff have a good understanding of issues relating to loss and bereavement and are able to use this knowledge to offer support when required. EVIDENCE: Service user plans and records provided up to date information about healthcare needs. Since the last inspection the Registered Manager has developed this information to include detailed information where health are considered more complex. This information included issues relating to consent, medication, staff training and other agency involvement. This format of recording is considered very good practice. A range of daily charts are used to monitor individuals health needs and any changes are dealt with promptly. An example was given relating to the monitoring of an individuals mood and behaviour and how this was used to identify a possible health problem. Records were seen for all service users receiving prescribed medication. A record is kept of all medicine received, administered and returned to the pharmacy. The home uses a ‘Potting Up’ System, and discussion took pace with the manager for the need to ensure that the homes current system is in line with the ‘ Royal Pharmaceutical Guidelines for Medication in Care Homes’. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 15 All daily medication sheets were signed and dated and staff receive in-house medication training. Staff had a good awareness of issues relating to loss and bereavement, and have had to support service users following the death of a family member. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users can feel confident that any complaints are taken seriously and opportunities are explored to ensure that each individual can express their views and be listened to. Staff in the home have a good knowledge of Adult Protection issues and relevant training is arranged for all the staff team. EVIDENCE: Neither the home nor the Commission for Social Care Inspection have received any complaints regarding the service since the last inspection. The home has a complaints procedure, which was available within the Statement of Purpose. Due to the high dependency and limited communication of most service users it is necessary for the home to have a range of methods to establish if service users have a problem or if they wish to express a concern. It was evident that staff are aware of the communication methods of service users and were responding promptly to individual requests. A key-worker system is in place, as well as daily recording and staff meetings. Service user meetings take place and staff are looking at ways of developing this to ensure that each individuals views can be expressed and listened to. The management and staff team are aware of Adult Protection issues and different types of abuse. ‘Adult Protection’, and ‘Behaviour Management’ training has been undertaken or is planned as part of a rolling programme for all staff. All service users require support to manage their finances. Service user skills in this area and the responsibility of the home or others were not documented within the service user plan. The Registered Manager advised that many attempts have been made by the home to arrange individual bank accounts for service users, but this has not been possible. Service users do have individual post office accounts. As Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 17 individual bank accounts are not available the benefits are paid into one account set up by the home, and the personal allowances and are then withdrawn and paid direct to the service user. A record is kept of all these transactions. The Registered Manager was advised that this arrangement does not meet totally with Care Standards Regulations relating to the handling of service users money and therefore should be reviewed. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 18 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): Service users live in a clean, safe, comfortable and well- furnished home. EVIDENCE: A tour of the communal parts of the house took place and two service users showed the inspector around their bedrooms. The home was found to be clean and hygienic throughout and the facilities and space were suitable for the current needs of service users. The house is well decorated and the first overall impression when entering the communal sitting room would be improved with new dining chairs to replace the current ones which appear tired and well used. Service users bedrooms were well decorated with lots of personal items and locks were available for those who choose or are able to use this facility. Bathrooms and toilets were clean and tidy and various items of equipment had been provided to assist with daily personal care tasks. Risk assessments have been completed for the need for water temperature valves, radiator covers and window restrictors and these have been fitted where a risk has been identified. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 The home has a small, experienced staff team who work well together to meet the current and changing needs of service users. EVIDENCE: Mrs Amanda Nicholson, the Registered Manager was not on duty on the day of the inspection but did make herself available to answer any queries raised by the inspector. The assistant manager was present throughout the day and was able to spend time with the inspector whilst attending to the many requests of service users for his attention. The manager advised that the staff rota is planned weekly dependent on activities and more staff are available when service users are not at day centres. There are always three staff on duty in the morning before service users go out for the day and again in the evening and weekends. There is one waking and one sleeping night staff. The staff rota confirmed these arrangements. All staff members spoken to were very aware of service users needs and their own role within the home. Since the last inspection three members of staff have completed Behaviour Management training, and senior staff have arranged to attend training relating to the care of service users with Diabetes. Records confirmed that statutory health and safety training is regularly updated and staff are keen to attend training specific to the home and individual needs. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 20 Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 EVIDENCE: Mrs Nicholson, the joint provider and Registered Manager has obtained the Registered Managers award. She also has a Nursing Qualification (RNMH), and has many years experience in working with people with a Learning Disability. Throughout the inspection staff and management were open and supportive and demonstrated a positive and inclusive style of working. The assistant manager and staff were keen to discuss and consider any suggestions and recommendations to further improve practice. The home has a quality insurance system, which includes service user and relative questionnaires, and service user meetings are documented to ensure that every-ones views are recorded and addressed. The current quality assurance system does not allow for the home to gather feedback from outside agencies, and this should be considered. In addition to daily contact, supervision and handover meetings the home also has three formal full staff meetings per year. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 22 A system of monthly checks is in place to address Health and Safety in the home. Records were seen and found to be well maintained and up to date. The assistant manager was aware of changes to Food Hygiene Legislation and said that arrangements would be made to access necessary details and incorporate the changes into the homes policies and procedures. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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 4 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 x x 3 x Clearview DS0000003465.V263050.R01.S.doc Version 5.1 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 YA23 Regulation 20 Requirement The Registered Provider must provide details to the Care Standards Commission of the Account set up by the home to manage service users finances. Timescale for action 01/03/06 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 YA6YA6 Good Practice Recommendations The Registered Provider should ensure that service user plans are sufficient in detail to identify how assessed needs will be met and should include any specific guidelines for staff Service user plans should include details of service user skills relating to finance and details of the support required. The Registered Provider should give consideration to incorporating Person Centred Planning into the Care planning process to ensure a more holistic and long- term outlook. The Registered Provider should explore the availability of Advocacy services to support service users through a DS0000003465.V263050.R01.S.doc Version 5.1 Page 25 2 YA13YA13 Clearview 3 YA16YA16 period of change, particularly regarding changes to day services. The Registered Provider should review the use of baby monitors in the home, and ensure that this facility is only used for a period of time that has been agreed as part of a multi-agency review. Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clearview DS0000003465.V263050.R01.S.doc Version 5.1 Page 27 - 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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