Inspection on 11/10/06 for Conifers

This inspection was carried out on 11th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Conifers 18/12/07

Conifers 24/10/05

Conifers 24/05/05

Conifers 17/11/04

Conifers 29/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Conifers 48 Avenue Road Trowbridge Wiltshire BA14 0AQ Lead Inspector Ms Sally Walker Key Unannounced Inspection 11th October 2006 09:05 Conifers DS0000028218.V295942.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 Conifers DS0000028218.V295942.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. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Conifers Address 48 Avenue Road Trowbridge Wiltshire BA14 0AQ 01225 776855 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) Mrs Ann Elizabeth Leonard Mr Peter James Leonard Mrs Ann Elizabeth Leonard Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2005 Brief Description of the Service: Conifers is registered for 3 younger adults with learning disabilities. The home is a large semi-detached Victorian house close to the centre of Trowbridge. Mr and Mrs Leonard live on the premises. The residents’ accommodation is all single bedrooms and all are to the first floor. There are 2 large sitting rooms, a dining room, kitchen and bathroom with toilet to the ground floor. On the first floor there are the staff sleeping in room, a large bathroom and separate toilet. There is a large enclosed garden to the rear of the property. Currently Mr and Mrs Leonard provide the care and support for one resident and no staff are employed. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 11th October 2006 between 9.05am and 12.20pm. Mr and Mrs Leonard were present during the inspection. The care records, medication records, arrangements for money held on residents’ behalf, fire logbook and menus were inspected. A tour was made of the communal space. The weekly fee was dependent on the resident’s care needs; just over £1600.00. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: 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. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 6 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 Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 7 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): 0 No residents have been admitted to the home for sometime so this standard could not be assessed. EVIDENCE: No new residents have been admitted for some time. Mrs Leonard carries out the pre-admission assessments. She takes into consideration the current resident’s care needs when deciding on whether the home can meet prospective residents needs. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 8 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 & 9 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The resident benefits from a detailed care plan identifying their changing needs. Much effort has been made to encourage communication, to make wishes known and to make day-to-day choices in their life. Risk assessments were not a restriction to prevent residents from doing things they wanted to do. EVIDENCE: The care plan format identified all of the care needs. The care plan was reviewed and revised in February 2006. The daily report was set out in relation to each aspect of care and support, communication, activities, self help, medical appointments, mood and specific monitoring requirements. It was evident from observation and from the daily report that much effort had been made to develop communication and decision making since the last inspection. Promoting more control for residents over their daily life, they were able to express themselves and behaviours had significantly reduced. Times to get up and go to bed were dependent on what was planned for the day. Residents were encouraged to choose what they would wear. Risks to the resident regarding activities that they were involved in both at the home and in the environment had been recorded with action taken. The inspector advised that where a listening device was used at night clear guidance on its Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 9 use must be recorded in the care plan. Mrs Leonard said it was rarely used, only if the resident was ill and in this case she would sleep in the adjacent bedroom. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 10 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 & 17 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Activities were based on the resident’s particular engagement with certain preferred activities. Local facilities were regularly used. Family contact was encouraged with regular home visits. Preferred daily routines were recorded. A healthy diet was provided according to preferences. EVIDENCE: Courses at the local college have been attended in the past together with various local day services. Employment had not been possible. Mr and Mrs Leonard were considering other suitable activities as the resident had refused some events. Activities included: a walk every day, shopping, trips to Longleat, a bison farm and other places of interest, swimming, cinema and visits to ex-staff and Mr and Mrs Leonard’s family and friends. Regular contact with family was encouraged and monthly weekend stays. Mr and Mrs Leonard had provided 2 holidays in Wales and Devon. A record was kept of meals taken each day. Choice was available for breakfast and drinks throughout the day. Meals are provided taking into consideration preferred choices with some new dishes introduced for variety. Choosing some Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 11 ingredients and treats was encouraged when helping with the food shopping. All of the meals were made with fresh ingredients. Mr Leonard enjoyed cooking and talked about some of the new dishes. Both the lunch and evening meal comprised a cooked meal and a pudding. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 12 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, 19 & 20 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Preferred personal support routines are followed. Residents have good access to healthcare specialists. Systems were in place for safe administration and control of medication. EVIDENCE: All personal intimate care and support was provided by Mrs Leonard in private. The care plan identified the resident’s own preferred routine for the giving of personal care and grooming. Mr Leonard was involved with supporting during other activities, for example, meals, trips in the locality and enabling the resident to make choices. The resident was supported to buy their own clothing, which was of good quality and reflected their personality. They were very well groomed. The resident had good access to healthcare specialists and consulted a dentist regularly. The medication was stored out of reach. Records were kept of all administrations. Specific medical conditions were noted in the care plan. Pain relief was available when identified. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 13 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 & 23 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Systems were in place for residents and their representatives to make complaints about the service. The home worked to the local Protection of Vulnerable Adults process. EVIDENCE: The home has a complaints procedure a copy of which had been made available to relatives and representatives. There had been no complaints made either to the home or to the Commission. A copy of the local Protection of Vulnerable Adults policy and procedure was available as was the home’s own policy on protecting residents from abuse. Named personal savings accounts were encouraged with Mrs Leonard as the appointee if residents were unable to manage the accounts. This had been agreed with the resident’s family. Mrs Leonard kept records and receipts of all financial transaction made on behalf of the resident including their personal allowance. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 14 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 & 30 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home offers a homely, comfortable, clean and well maintained environment to residents. EVIDENCE: The home was maintained to a very high standard reflecting the Victorian building. Mr and Mrs Leonard are resident with a flat on the top floor. Residents have access to all the communal areas and rear enclosed gardens. There were 3 bedrooms on the middle floor only 1 of which was currently occupied. The room was newly decorated and furnished and fitted to a very good standard. The resident had personalised their large bedroom, which was light, airy, clean and comfortable. A safety barrier at the top of the stairs, an extension of the banister, had been approved by the Fire and Rescue Authority when the home was first opened. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 15 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): 0 No staff are currently employed so these standards could not be assessed. EVIDENCE: Staff had been employed in the past and all the relevant policies and procedures were in place should staff be appointed in the future. No staff were currently employed. However it was reported that when new residents were admitted, staff would be recruited. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 16 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, 39 & 42 The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is run in the best interests of the residents. Mrs Leonard was completing the Registered Managers Award and Mr Leonard had NVQ Level 2. Although no formal quality monitoring was in place, Mr and Mrs Leonard had regular contact with family for comment on the service. Mr Leonard maintains records of all checks and servicing of equipment and the environment for the safety of residents. EVIDENCE: Mr and Mrs Leonard set up the home over 7 years ago. Mrs Leonard has over 30 years experience of working with people with learning disabilities both as a teacher and in different care homes. Mr Leonard’s background is in business but he has gained his experience in the time that the home has been operating. He has an NVQ Level 2 in care. Mrs Leonard had commenced NVQ Level 4 and expected to gain the Registered Manager’s Award by March 2007. She keeps herself up to date with current good practice through her membership of ARC, the Association for Real Change and other information on the internet. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 17 Although no formal quality assurance monitoring was in place, Mr and Mrs Leonard had regular contact with family for comments on the service. It was evident from the care plan that the resident’s communication had improved and their views were taken into consideration when planning their care and leisure time. Mr Leonard keeps a record of all the health and safety and fire safety checks he or a contractor carried out on all the equipment and facilities in the home. Environmental risk assessments had been reviewed in April 2006. Personal risk assessments were found in the resident’s file. Although no staff are employed Mrs Leonard retains the policies and procedures documents for her own reference. Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 N/A 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 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 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 19 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 YA9 Regulation 13(4) Requirement The person registered must ensure that written guidance is available in the care plan and risk assessment regarding the use of any listening device. Timescale for action 11/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Conifers DS0000028218.V295942.R01.S.doc Version 5.2 Page 21 - 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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