CARE HOME ADULTS 18-65
Clevedon House 70 Clevedon Road Weston Super Mare North Somerset BS23 1DF Lead Inspector
Catherine Hill Unannounced Inspection 15th March 2006 2:20 Clevedon House DS0000008083.V268506.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 Clevedon House DS0000008083.V268506.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. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Clevedon House Address 70 Clevedon Road Weston Super Mare North Somerset BS23 1DF 01934 624836 01934 624836 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) Freeways Trust Limited Miss Shelley Ann Holvey Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th August 2005 Brief Description of the Service: Clevedon House is part of the Freeways Trust and is a community home for people with a learning disability. It is situated in a quiet residential area of Weston, close to local amenities, the seafront and the town centre. The home is two converted semi-detached Victorian houses. Most of the residents are in their forties or fifties, although a couple of people are over retirement age. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was done during the course of one afternoon, when most of the residents were at home. It focused on spending time with the people who live in the home, talking with staff, and on requirements and recommendations made at previous inspections. The inspector spoke with six of the residents in depth but also spent time in the lounges with some of the others. One of the residents gave her a guided tour of the communal areas of the home. Since the last inspection, a new manager has been registered. She and the team have been looking at ways they can build on existing strengths and improve practice and residents quality of life in other areas. The team is increasingly looking at ways of putting residents at the centre of the way the home is run, and at creating more opportunities for people to exercise choice and independence. Key workers monthly reports are more regular and more informative, and the daily records give a clear picture of all sorts of aspects of the persons life. Residents described a really interesting range of social, leisure, and vocational activities. The staff team is very creative about how support is provided to people in this aspect of their lives. What the service does well: What has improved since the last inspection?
Residents feel that they are being treated more consistently as equals by staff. Most staff were always very good at this, but there were some aspects of the team’s practice that did not empower residents. Residents and staff gave
Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 6 several examples of practices that have changed to put the residents more in charge. Residents are also having more say in the home. These subtle changes seem to have had quite a profound effect on both the residents and the staff, and many people said how much happier they are feeling lately. The environment has been improved indoors and out. The conservatory lounge has been redecorated and recarpeted, and is a much more attractive room as a result, although it would benefit from new furniture covers. Bathrooms have been tidied, and quotes are being taken for installing a new walk-in shower. Separate sleeping-in facilities have been set up now, so that staff are not using a communal room. A bit more work has been done on the garden, which is looking very nice, and staff have helped one resident with a special interest to plant up pots of spring flowers. The Key Worker reports sampled gave much clearer information on what action has been taken to support the person to achieve their goals, and showed that actions are being carried out more promptly than previously. Residents have traditionally had regular days when they work one-to-one with a member of staff, but this idea has been expanded to emphasise the pleasurable activity aspect of it, rather than the household chores aspect. Residents were very enthusiastic about this: many people are able to do their own chores with a minimum of support, but appreciate the chance to have staff support with other less routine activities. 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. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 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 Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 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): 1 Prospective residents have good, up-to-date information about the home. EVIDENCE: Since the last inspection, the Statement of Purpose has been updated to show the recent changes in staff. The home’s emergency admissions procedure says that the Trusts Chief Executive will make the final decision about who is admitted to the home in the event of a disagreement, but the Care Standards Act 2000 requires that it is the registered manager who makes this decision. The admission procedures should be amended to show that it is the decision of the homes manager whether to admit a resident. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9 Residents personal goals and needs are clearly documented and well met. EVIDENCE: The care plans seen gave clear information on what each person hopes to achieve and the support they need from staff to do this. At least two entries are made on each persons care notes every day, and these combined to provide a really informative picture of the sort of activities people are able to participate in, any changes in mood or any significant events in the persons life, any new needs that arise, and what is being done to support the person. One of the residents has put the yellow Health Action Plan booklet on the agenda for the next residents meeting. Staff will be starting to support residents to formulate and carry out their own health action plans. Files have been put into order so that current information is much more easily accessible, and out of date information is now being filed separately. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 10 Residents are being consulted more widely on issues that affect their lives in the home, and are being given more control in a multitude of small ways. Residents meetings have long been a regular event, but residents are gradually taking on more responsibility within these. The agenda for the next meeting was pinned up on the residents noticeboard, and one of the residents told the inspector about the issue she has added to the agenda for discussion. Another resident had helped to write up some of the minutes from previous meetings. Lots of information on community events was pinned up on the residents noticeboard, along with an updated user-friendly copy of the complaints procedure, a copy of the home’s Ground Rules agreed by the residents, and a list of key workers. A user-friendly version of the staff rota has been designed and is kept up-to-date by residents and staff. The activities days timetable is also on this noticeboard in a similar format to the staff rota so that residents can more easily see when their activities day is scheduled and who with. The inspector also noticed that every time the doorbell rang during this visit, one of the residents automatically went to answer it. The person who let her in at the start of the inspection checked her identity. Several comments were made to the inspector that indicated residents feel staff take them and their views more seriously, and that things change nowadays as a result of residents making their views known. An issue that came up at some previous inspections was the way staff relate to residents: sometimes some of their approaches were felt to be parent-to-child rather than adult-to-adult. Residents felt that, while this is not completely resolved, it is greatly improved. The changes in practice and the fresh emphasis on residents being in control have had a subtle but profound effect. There was quite a different atmosphere in the home at this visit, and several residents or staff commented to the inspector how much happier they are now. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11-14, 16-17 Residents are being offered more choice and control over their lifestyles, and get lots of opportunities for interesting activities. EVIDENCE: The activities timetables supported residents descriptions of a full and varied lifestyle. Some people have paid employment with contracts and job descriptions within the home, some have voluntary jobs outside the home, and some attend college courses and day centres. Residents also get lots of opportunities for an interesting social life. One person who is retired said that they are not bored at home because there is still plenty of interest going on. Several people were setting off on a trip to Oxford to watch a football match this afternoon, and other people were planning a trip to the cinema. Equipment has been provided in the kitchen to enable more residents to make their own drinks. Residents and staff jointly draw up the menus for the week ahead. The inspector recommended at the last inspection that ways of involving the residents in meal preparation should be considered, rather than
Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 12 staff simply preparing the meals themselves. This is now an integral part of the one-to-one activity days that each resident regularly has. Staff still tend to prepare the evening meal, but residents are more involved at lunchtime. At the time the last inspection, staff were exploring the possibility of using a voice-activated computer program so that residents could be more involved in doing the minutes of their meetings. One of the staff is exploring the possibility of getting Internet access so that residents can use online chat rooms and information web sites. Freeways Trust has its own web site run by and for people with learning disabilities. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were not assessed at this inspection. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 15 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, 27-30 The communal environment is very pleasant but bathrooms still do not meet residents needs. EVIDENCE: The conservatory lounge has been redecorated and recarpeted, and is now a much more attractive and pleasant room. Roof and window blinds are due to be fitted soon. Most of the furniture in this room is quite badly faded from exposure to strong sunlight, and the arms of one of the easy chairs near the French windows are worn through. The furniture needs to be replaced or recovered as necessary. The missing tiles that were noted in some of the bathrooms at the previous inspection have been replaced, and the broken equipment has been removed from these rooms. They are tidy and homely but most still need repainting and fresh sealant. The first-floor bathroom particularly needs to be repainted, and a lot of the sealant around the bath and hand basin is black with mould. There are a number of damp stains on several ceilings of the upper two floors that need to be made good. Some structural work is about to be carried out to the upper storeys, and upstairs areas will be redecorated afterwards.
Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 16 The room that used to be the office has been turned into a sleeping-in room and area for writing up residents care notes. The adjoining office provides a more private place for quiet work. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 17 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): Boy EVIDENCE: These standards were not assessed at this inspection. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 18 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): EVIDENCE: These standards were not assessed at this inspection. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 19 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 X 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 X 23 x ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTH CARE SUPPORT Standard No 18 19 20 21 Score X X X x X X X X X X X Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA27 Regulation 23 Requirement Bathrooms must be suited to residents needs and lifestyles. This requirement was first made on 03/02/05. The conservatory lounge furniture needs to be replaced or recovered as necessary. Timescale for action 15/06/06 2. YA28 23 15/05/06 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 YA3 Good Practice Recommendations The admission procedures should be amended to show that it is the decision of the homes manager whether to admit a resident. Clevedon House DS0000008083.V268506.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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