Inspection on 18/12/07 for Conifers

This inspection was carried out on 18th December 2007.

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 11/10/06

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 Sally Walker Unannounced Inspection 18 December 2007 09:15 th Conifers DS0000028218.V349614.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.V349614.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.V349614.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.V349614.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2006 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. Information about the weekly fees for the service can be obtained directly from the home. Conifers DS0000028218.V349614.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 18th December 2007 between 9.15am and 12.20pm. Mr and Mrs Leonard were present during the inspection. We looked at care records, medication records and menus. We made a tour of the communal space. As part of the inspection process we sent survey forms to the home to distribute to residents, families, care managers and healthcare professionals. Comments can be found in the relevant part of this report. We also asked Mrs Leonard to complete the Annual Quality Assurance Assessment that is required. This was completed in full. 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: The care plan is comprehensive and shows how the assessed needs are to be met and monitored. The daily report shows good detail of how the care plan is implemented together with how the resident is supported in their daily life. Mr and Mrs Leonard have built upon the resident’s preferred methods of communication. This has enabled the resident to make more decisions about how they live. Risk assessments do not restrict the resident from doing the things they want to or from experiencing new challenges. Personal support is provided according to the resident’s preferred routines. The resident has good access to healthcare professionals when needed. Safe systems are in place for the administration of medication. The resident has good access to the locality with support from Mr and Mrs Leonard. Activities are made available according to the resident choice. Activities take place everyday. Contact with family is maintained. A healthy diet is available. Mr and Mrs Leonard ensure that the resident has at least 2 different holidays with them each year. Good relationships have been established with the resident. Suitable arrangements are in place for supporting the resident with their finances. This has been agreed with the resident’s family. The environment is very well maintained, warm, clean and homely. Mr Leonard ensures that regular maintenance and the relevant health and safety checks are carried out. Conifers DS0000028218.V349614.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. Conifers DS0000028218.V349614.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 Conifers DS0000028218.V349614.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): 0 Quality in this outcome area could not be assessed as no new residents had come to the home. This judgement has been made using available evidence including a visit to this service. No new residents had been admitted to the home so we were unable to assess this standard. EVIDENCE: No new residents have been admitted to the home for some time. However Mrs Leonard told us she will carry out extensive pre-admission assessments on any prospective residents to make sure their needs can be met. The needs of the current resident would be taken into consideration before deciding whether a placement could be made. Conifers DS0000028218.V349614.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. The resident benefits from a detailed care plan showing how their assessed needs are to be met and monitored. Mr and Mrs Leonard continue to build upon the resident’s own communication methods. This means that the resident has much more control over their daily life. Risk assessment does not restrict the resident from doing things they like to do or from experiencing new challenges. EVIDENCE: The resident had a care plan, which was regularly reviewed by Mrs Leonard. This showed details of the care and support needed and how the needs are to be met and monitored. Risk assessments had been carried out with all activities that the resident may be involved in both at the home and in the locality. The daily record showed how the assessed needs were being met according to the care plan. There was evidence of what the resident did each Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 10 day, how they were feeling, things they did for themselves, any healthcare interventions and how they communicated. We made a requirement at the last inspection about written guidance on the use of a listening device. Mrs Leonard said that the device was not needed anymore so was not used. Conifers DS0000028218.V349614.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, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident decides what activities they want to be involved in. They have good access to the locality. Contact with family is maintained. The resident enjoys a healthy diet. EVIDENCE: Mrs Leonard said that activities were geared to the resident’s interest in exploring the environment. They liked to go for walks with the dog. They also took an interest in helping with the weekly shopping. They were planning to go Christmas shopping that week. Mrs Leonard said she continued to seek different opportunities for the resident, although they had chosen not to attend college, riding and swimming. As the resident enjoys animals, they have a yearly pass for Longleat. The resident enjoys regular trips to stay with their family for a weekend. Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 12 Mrs Leonard told us that they were encouraging and building on the resident’s verbal skills, which continued to increase. The resident will also take Mr or Mrs Leonard to different items to indicate what they want to communicate. The resident was able to communicate refusal or dislike. Mrs Leonard said the resident would make decisions about when they wanted to go to bed or get up. The resident had had 2 holidays to Wales and Devon in the summer. We were shown photographs of the activities that the resident was involved in on the holidays. This included going to the pub and exploring textures whilst out walking. Records were kept of what meals the resident ate each day. All meals were home cooked from fresh ingredients sourced locally. Meals were planned according to the resident’s likes and dislikes. There was a hot meal for lunch and the evening meal. It was clear that the resident had a balanced, healthy diet with plenty of fresh fruit. They were having a breakfast of sandwiches, a biscuit and satsumas with a hot drink. The resident was able to show when they wanted drinks or something to eat. In a survey form a healthcare professional wrote: “The individual they are caring for does tend to have a lot of sweet things, which we have witnessed during out visits but we have not been at the home when meals are prepared, so cannot comment on nutritional balance.” Conifers DS0000028218.V349614.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and support is provided according to preferred routines. Healthcare needs are being met with regular review. The resident benefits from good access to healthcare professionals. Systems are in place for safe administration of medication. EVIDENCE: All intimate personal care is provided in private by Mrs Leonard. The care plan showed good detail of the resident’s preferred morning and night time routines. Mr Leonard was also involved in providing support with meals, trips to local facilities and encouraging communication and choice. The resident was well groomed. They had chosen their own clothing which reflected their personality; that of a younger adult. The resident has regular access to healthcare professionals, specialist consultants and the dentist. Separate records were kept of all appointments and interventions. Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 14 We examined the arrangements for administration and storage of medication. Records were kept of all administrations. The medication was suitably stored. In a survey form a healthcare professional wrote: “The care provider always appears to allow the individual to express their needs of how they want to live their lives, with constant supervision in the home and garden. I understand that the care provider is undertaking an NVQ. The care provider has a very good relationship with the individual who has complex needs and appears to respond well to these needs.” Conifers DS0000028218.V349614.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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place for people to raise concerns or make complaints about the service. No complaints had been made since the home opened. Mr and Mrs Leonard were familiar with the local Safeguarding Adults procedure. Arrangements for finances are agreed with the resident’s family. EVIDENCE: There is a complaints procedure in place. This has been made available to relatives and others involved in the resident’s care programme. The home works to the local Safeguarding Adults procedure. Copies of the local policy entitled ‘No Secrets in Swindon and Wiltshire’ were available. We advised that the home’s own policy on Safeguarding Adults needs to be reviewed and revised in line with the local policy to show the point at which the police must be alerted. Mrs Leonard supported the resident with managing their money with records and receipts of all purchases and other transactions. The resident is encouraged to save in their own named account. All the financial arrangements have been made in agreement with the resident’s family. In a survey form a healthcare professional wrote: “When asked about marks on individual’s side a clear explanation given and later community nurse witnessed the reason for the marks, which were self inflicted.” Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident benefits from a homely, comfortable, clean and well maintained environment that they can access as they wish. EVIDENCE: The resident has a large bedroom which is warm, light and airy. There are two other bedrooms registered but they were unoccupied. The décor and furnishings reflect the resident’s personality. The building is very well maintained and decorated to reflect the Victorian building. Mr and Mrs Leonard live on the premises. The resident has the choice of two sitting rooms. There is a large television which the resident enjoys watching. The resident has supervised but unrestricted use of the garden. A safety barrier at the top of the stairs; an extension of the banister, was approved by the local Fire and Rescue Authority when the home first opened. Mrs Leonard said that it was rarely used now as the current resident had little risk of falling down the stairs. Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 17 The home was cleaned to a high standard. Laundry is done on a domestic scale. Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 0 Quality in this outcome area could not be assessed as no staff are currently employed. This judgement has been made using available evidence including a visit to this service. These standards could not be assessed as staff are currently not employed. EVIDENCE: As staff had been employed in the past, all the relevant policies, procedures and documentation were on file. We were told that if any further residents were admitted, then staff would be recruited. Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. 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. The resident benefits from a well run home. Mrs Leonard recently gained the Registered Managers Award. She has many years experience of working with younger adults in educational and residential settings. Although no quality monitoring system was in place, Mrs Leonard completed the Annual Quality Assurance Assessment we required. Mr Leonard ensures that all health and safety checks and maintenance are regularly carried out. EVIDENCE: Mr and Mrs Leonard opened the home over eight years ago. Mrs Leonard is the registered manager. She has over thirty years experience of working with younger adults with learning difficulties both as a teacher and in various care homes. She has recently completed the Registered Managers Award and Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 20 submitted her work for the NVQ Level 4 in management and care. Mr and Mrs Leonard keep themselves up to date with current good practice through their membership of ARC; the Association for Real Change and from relevant information on the internet. Although Mr Leonard comes from a business background, he has gained experience since the home opened. He has NVQ Level 2 in care. Although he provides no personal care, he works closely with the resident. It is clear that they have a good relationship. Regular checks and maintenance of systems and equipment for fire safety are kept. Mr Leonard ensures that maintenance and other safety checks on the environment are recorded together with any remedial action. Mrs Leonard had recently reviewed and revised al of the home’s policies and procedures. Although no staff are employed, the policies and procedures are retained for Mr and Mrs Leonard’s own reference. There is a policy for auditing the quality of care, but no formal audit was evidenced. Mrs Leonard said she had sent out questionnaires in the past to others involved in residents’ care programmes but had received no reply. However she has regular contact with the resident’s family so issues can be discussed. As part of the inspection process we asked for an Annual Quality Assurance Assessment to be completed. This was filled out in full. This showed the recent review of the service together with plans for development. In a survey form a healthcare professional wrote: “The relationship between carers and individual appears to be very good with plenty of humour, even at times when the carer has been exhausted because they have been unable to have respite. I feel there are times when the carers need more support in the way of respite as I believe they only have short breaks and have not had a holiday for years.” Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 N/A 33 X 34 N/A 35 N/A 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.V349614.R01.S.doc Version 5.2 Page 22 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 13(6) Requirement The person registered must review and revise their own Safeguarding Adults policy so that it relates to the local policy and states the point at which the police are alerted. Timescale for action 01/02/08 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.V349614.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Conifers DS0000028218.V349614.R01.S.doc Version 5.2 Page 24 - 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. 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