CARE HOME ADULTS 18-65
Curlews Dunsland Jacobstowe Okehampton Devon EX20 3RH Lead Inspector
Antonia Reynolds Unannounced Inspection 5th January 2006 2:40 Curlews DS0000032251.V269164.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 Curlews DS0000032251.V269164.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. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Curlews Address Dunsland Jacobstowe Okehampton Devon EX20 3RH 01837 810856 01837 810819 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) Atlas Project Team Limited Mr Michael James Brummitt Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users with a Learning Disability (4) Age 18 - 65 years Date of last inspection 20th October 2005 Brief Description of the Service: Curlews is a care home providing personal care and accommodation for four people, aged 18 – 65, with learning disabilities who may demonstrate behaviours that challenge services. It is owned by the Atlas Project Team Limited, which is a private sector organisation, owning several other care homes in Devon, Berkshire and Surrey. This home is located in a rural setting, and there are no close neighbours. The home provides transport for service users to access shops, pubs, and other amenities. The home was opened in 2002 and is comprised of a two-storey detached house. All the home’s bedrooms are single and two of these have en suite toilet and shower facilities. There are separate lounge and dining rooms, as well as a large sunroom on the ground floor. Part of the lounge room has been designated as a smoking area. The home has a very large garden, with parking facilities and a paddock at the back of the house. All areas are accessible to the service users. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 2.40pm and 4.10pm. The Registered Manager, Mike Brummitt, was present throughout the inspection and the Area Manager, Tim Stevens, was present for some of the time. A tour of the premises took place and records relating to service users and the home were inspected. Two of the three service users, as well as staff on duty, were spoken with and observed during the visit. Comments were received from a relative, expressing satisfaction with the care provided. 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. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 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 Curlews DS0000032251.V269164.R01.S.doc Version 5.1 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): 1, 2 and 4 The home’s Statement of Purpose and Service User Guide provide service users and prospective service users with details of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: No new service users have been admitted to the home since the last inspection. However, the organisation has a detailed admissions procedure where all prospective service users are assessed prior to admission by the senior management team within the organisation and have plenty of opportunities to visit. Service user guides have been produced in a photographic version for each person. Individual records are kept for each of the service users and discussion with the management team confirmed that specialised services were accessed if necessary. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 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): 7, 8 and 9 Service users are enabled to participate in, and make decisions about, all aspects of their lives. EVIDENCE: Discussion with service users and the Registered Manager confirmed that service users were enabled as much as possible to make decisions about their lives and participate in all aspects of life in the home, although the level of involvement depended on individual abilities and willingness. Service users participate in the day-to-day running of the home, including domestic activities and tasks, and staff support and assist where necessary. All the routines and activities are centred around service users’ needs and choices. Consultation with service users is very good and they are supported to take assessed risks if this will increase their independence and enhance their quality of life. The home is commended for the efforts made to ensure that a recent potentially risky situation was managed in such a way that the least amount of stress and anxiety was experienced by service users. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 9 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, 14 and 16 Service users can learn life skills, attend college, participate in any community and leisure activities and choose their own daily routines. EVIDENCE: Discussions with service users and the Registered Manager showed that people are enabled to take part in various leisure activities of their choice, unless the risk assessment indicates otherwise, such as meals out, shopping and using local community facilities. It was evident, through observation during the inspection, that service users consider this to be their home and are empowered to make decisions, in negotiation with the staff team. One of the methods of encouragement used is a development incentive programme where service users are paid for tasks achieved. The home provides two cars for use by the service users and staff are not expected to use their owns car to transport service users. Privacy is respected and bathroom doors are fitted with suitable locks. Bedroom doors have locks that are lockable from both sides with a key, however none of the service users have keys and previous inspections have shown that the reasons for this are documented. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 10 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 and 20 Service users can be confident that personal support is provided in the way, and at the time, that they want and need. Health care needs are addressed as soon as they are identified. EVIDENCE: Discussion with the Registered Manager confirmed that external professional advice and guidance is sought when necessary from local health care professionals or social services. The way the management and staff team managed a recent situation highlights the importance they place on promoting the best practice to protect a service users’ emotional health needs and this demonstrates excellent practice. Visits to and from health care professionals take place in private although staff are always present to facilitate communication and because of the needs of the service users. The Registered Manager confirmed that the system for the administration of medication has not been changed since the last inspection. Staff receive in-house training regarding the administration of medication and at least one staff member has completed a more comprehensive distance learning course. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 11 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 and 23 Service users are protected from abuse, neglect and self-harm. Service users can be confident that complaints are always dealt with seriously and any concerns from service users will be listened to and acted upon immediately. EVIDENCE: Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. The home has a complaints procedure and staff and management always respond immediately to any issues raised by service users or their relatives. Regular house meetings are held where any issues or concerns can be raised and dealt with immediately, although service users can raise any issue at any time. The management team are aware of adult protection issues and procedures and training has been undertaken, or is planned, for all staff members. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 12 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, 25, 26, 27, 28 and 30 The standard of the environment is very good, providing service users with an attractive and homely place to live. EVIDENCE: The home is large, comfortable, safe, clean and well maintained. The home’s lounge and dining rooms are comfortably furnished and there is also a sun room available for people to use. Decoration is ongoing and all the rooms are decorated to a good standard. The home is in a rural setting and two vehicles are provided to enable service users to access local amenities with staff support. It is evident that service users feel ‘at home’ in the environment and each service user has a large, single bedroom on the 1st floor, which are decorated individually and contain personal possessions. Two of the bedrooms have minimal furnishings due to the particular needs of service users. This situation is kept under review and redecoration is ongoing with furnishings being changed, increased or decreased depending on the service users’ needs. Bedrooms do not contain all the items as listed in the standard and previous inspections have confirmed that this is due to individual choice, or the items are not considered necessary, as the service users spend very little time in their bedrooms. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 13 Two of the bedrooms have en suite showers, toilets and wash hand basins. The other two bedrooms do not have wash hand basins due to the needs of the service users. On initial registration the use of the smaller two rooms was agreed on the basis that the occupants would have the sole use of a 5th room, for whatever purpose they chose, however they have never used this room as they prefer to use the main communal rooms. In addition to the en suite facilities the home has a bathroom with a toilet and wash hand basin on the 1st floor and two separate toilets on the ground floor, all of which are fitted with appropriate locks. The home has portable telephones for service users to have private conversations. The home has an office where staff could store belongings when on duty as well as a sleeping in room with a shower and wash hand basin. Kitchen and laundry facilities are satisfactory and service users are encouraged to do as much as possible for themselves. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 14 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): 32 and 33 Service users’ needs are met by high staffing levels. Service users benefit from well supported and supervised staff, creating a calm, relaxed and pleasant atmosphere in the home. EVIDENCE: The Registered Manager confirmed that the staffing numbers are usually two from 8am to 9am, three staff from 9am to 9pm, two from 9pm to 10pm and one waking night staff. In addition the Manager is present in the home on four days of the week. The care staff carry out the domestic and household tasks, whilst working with service users to be as independent as possible. The organisation operates an ‘on call’ system whereby members of the management team are available both in and out of office hours. Regular staff meetings take place which service users can also attend. The organisation has a training officer who maintains an overview of what the organisation requires, as well as ensuring that individual staff members receive the training they need. Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 15 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 and 42 The management approach of the home is open and positive and provides clear leadership, with the management team believing in leading by example. Service users’ rights, health, safety and welfare are protected and promoted. EVIDENCE: The Registered Manager has completed a level 4 National Vocational Qualification and the Registered Manager’s Award, and has commenced a Bachelor of Science degree in Intellectual Development and Disability. The home also has a Manager who is following the organisation’s trainee management scheme and is in the process of completing the level 4 National Vocational Qualification in Care and the Registered Manager’s Award. Lines of accountability are clear and the organisation has a management structure that enables it to cover absences when required, and provide an effective ‘on call’ system to support staff. The Manager confirmed that staff are consulted and included in any decisions regarding the running of the home. Monthly provider visit reports are being carried out and copies of the reports sent to the Commission for Social Care Inspection. No health and safety issues were identified during the visit.
Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 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 4 25 3 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 4 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 3 X X X X X Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 Curlews DS0000032251.V269164.R01.S.doc Version 5.1 Page 18 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
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