CARE HOME ADULTS 18-65 Darwell House Grange Court Maynards Green East Sussex TN21 0DJ
Lead Inspector Lucy Green Unannounced 23 April 2005 11:40 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 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 Stationary 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. Darwell House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Darwell House Address Grange Court Maynards Green East Sussex TN21 0DJ 01435 866468 01435 867519 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Opus Living Mrs Lynda Wilson Smith Care Home 15 Category(ies) of Learning Disability (LD) 15 registration, with number of places Darwell House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum service users to be accommodated is fifteen (15). 2. Service users will be aged between eighteen (18) and sixty-five (65) years on admission. 3. Service users will have learning disability as their assessed primary need. 4. One named service user with an acquired brain injury to be accommodated until 31st August 2005. Date of last inspection 29 November 2004 Brief Description of the Service: Darwell House is registered for fifteen younger adults with a learning disability. The home is a large, two storey, detached property which has been divided into two smaller units. One unit provides seven single bedrooms and the other has eight. Each unit has a large amount of communal space, separate kitchen and dining facilities and sufficient bathrooms and toilets. The service stands alongside its sister home, in ten acres of ground in Maynards Green, near to Heathfield town, with shops and public transport links. Some of the land is utilised by service users for sport, allotments and gardens. Darwell House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3.5 hours on Saturday 23 April 2005. This is the first statutory inspection of this year. Since the last inspection the home has divided into two smaller units with separate staff teams who are overseen by one Registered Manager. A tour of the premises took place, rotas and care records were inspected. Seven of the eleven service users and five staff members were spoken with. Following the inspection, the Inspector telephoned five relatives for feedback on the home. The Inspectors observed the lunchtime meal being served. Due to the size of the home, the inspection was carried out by two Inspectors. The Lead Inspector was responsible for contacting relatives and writing the report. What the service does well:
The environmental improvements to the home have created a homely and relaxed atmosphere, whereby service users have begun to take ownership of their surroundings. The location of the home provides service users with the freedom to wander within a secure environment. A number of changes to the staffing structure at Darwell have lead to service users being supported by a caring and committed team of staff. The team now provides both long standing knowledge and fresh input. Service users and relatives spoke highly about the services offered at the home and described the staff as friendly and caring. One relative said his son had described himself as “lucky to have two homes.” Another service user said “the home is his life, he talks about it continuously”. Meals are varied, balanced and well presented offering both choice and variety. Service users are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. Relatives confirmed that they were kept fully informed about healthcare issues and invited to attend reviews. The home has a good system for managing medication safely. Darwell House Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Darwell House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Darwell House Version 1.10 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 standard(s) 2 & 4 Prospective service users have the opportunity to see if the home will be able to meet their needs before they accept a permanent placement. EVIDENCE: At the time of the inspection, one prospective service user was undertaking a trial visit at Darwell House. Staff spoken to confirmed that this person was on a weekend stay following a succession of other visits. A skeletal care plan was found to be in place for this individual, which included a copy of a comprehensive social care assessment and details of his support needs. The monitoring visits carried out by Opus Living in accordance with Regulation 26 of the Care Homes Regulations confirm that this prospective service user has been visiting the home so that all parties can assess if this is a suitable placement. Darwell House Version 1.10 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 standard(s) 6, 7, 8 & 9 Service users are involved in developing the plans in place to support them. Risk assessments do not fully reflect the level of risk involved in some activities and how this is affected by the controls in place. EVIDENCE: The care plans for six service users were viewed and there was evidence that significant improvements had been made since the last inspection. The system of care planning now provides support plans to guide staff in the delivery of identified care needs. There was evidence that service users have been consulted in developing their care plans and those who are able have signed their name in agreement with the information held on them. The Inspector telephoned five relatives, who confirmed that they were invited to participate in the reviewing process and received minutes from meetings held. Care plans identify goals for individual service users which are then monitored as part of the ongoing review process. At this time, the goals are fairly basic and it is hoped that as this system develops, peoples’ experiences and aspirations will progress.
Darwell House Version 1.10 Page 10 The home has a range of risk assessments in place in respect of varying aspects of service users’ lives. Some further work in this area is required to ensure the risks associated with all activities are considered. Many of the risk assessments in place require additional information about the affect controls in place have on the level of risk. Darwell House Version 1.10 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 standard(s) 11, 12, 13, 14, 15 & 17 Service users would benefit from a more robust programme of fulfilling activities. The home promotes positive relationships between service users and their relatives. Service users enjoy a range of appealing and nutritious meals. EVIDENCE: The inspection took place on a Saturday and during this time service users were observed watching television. Staffing levels were adequate for the number of service users and it was disappointing that across the 3.5 hours of inspection, service users were not engaged in more fulfilling activities. The six care plans and activity programmes viewed highlighted that activity programmes need to me more robust to enable all service users the opportunity to engage in meaningful activities. It was noted that some service users attend college courses and other day services, but many of the activities appear to be ad hoc. Two service users informed the Inspectors that they would like to go out more often. A senior member of staff stated that outings are arranged, including a day trip to Hastings which had occurred the previous
Darwell House Version 1.10 Page 12 day. It would seem that the unreliability of the vehicles, which was identified at the last inspection, continues to be a problem. The Inspectors were also informed that only a few staff are able and willing to drive the minibus which poses as a problem. The home has worked hard at developing and maintaining relationships between service users and their relatives. A communication book is now in place which documents the contact each service user has had with their family. It was noted that some service users write to their relatives, whilst others are supported to telephone home. At the end of the inspection, the Inspector telephoned five relatives who all spoke highly of the services provided at Darwell House. All relatives spoken to confirmed that they were made to feel welcome and included at the home. Two relatives who both live some distance from the home, told the Inspector that staff facilitate contact by providing transport to their homes or meeting at a mutually convenient location. The lunchtime meal in both units was observed and found to be appetising and well presented. Menus viewed were varied and service users spoke positively about the food they receive. One service user told the Inspector he regularly had his favourite meal cooked for him. The five relatives spoken to said they had never heard any complaints about the food at Darwell and that personal choices and preferences were always respected. Two relatives expressed some concern about weight gain, although a follow-up conversation with the Manager revealed that input from the dietician had been sought. Darwell House Version 1.10 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 standard(s) 18, 19 & 20 Staff have the knowledge and experience to meet the health care needs of the service user. Medication is handled safely and appropriately. EVIDENCE: It was observed during the inspection that personal care is provided with dignity and respect. The six care plans viewed contained support plans to guide staff in the delivery of care and staff were observed following these guidelines. Service users are able to make choices about how they are supported and who assists them. At the time of the inspection, a member of agency staff was able to describe the morning routine of the service user he supported. The service user confirmed that the support provided matched his expectations. The Inspector telephoned five service user relatives following the inspection to gain feedback. All representatives spoken to confirmed that health care needs were always addressed and they were kept well informed about the health of their relative. Medication is stored, dispensed and administered appropriately. The two senior staff on duty confirmed that only staff who had received relevant training were permitted to administer medication. Staff interviewed stated the
Darwell House Version 1.10 Page 14 correct medication procedures to be followed with confidence. There was evidence that the systems in place ensured medication was managed in an individually focussed way and was not simply task orientated. Darwell House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users and relatives are able to express their opinions which they know will be listened to. Adequate systems are in place to protect service users from abuse. EVIDENCE: All service users spoken with were able to explain what they would do if they were not happy about any aspect of their care. Similarly, the relatives expressed that should they wish to raise a complaint they would either inform care staff on duty or speak to the Manager. Staff were aware of the home’s complaints procedure and what to do if someone complained to them. It was not possible to view the complaints file as this was locked in the Manager’s office, however, on previous inspections this has been viewed and found to be appropriately maintained. The management team at Darwell House have invested a large amount of time and effort over the past year in promoting the protection of vulnerable adults. The Inspector is now confident that staff are fully aware of what constitutes abuse and the measures they need to take both to prevent abuse from occurring and what to do if an incident occurs. Since the last inspection, the home has appropriately reported a number of incidents triggering adult protection action, which has raised compatibility issues about certain service users living together. Since the inspection and the publication of this report, the matter has been satisfactorily addressed. Darwell House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Service users benefit from a clean, comfortable and well-maintained home. EVIDENCE: Darwell House is an adapted two storey, detached property situated alongside its sister home, in ten acres of ground in Maynards Green. Since the last inspection, the home has been divided into two self-contained units. Accommodation for fifteen service users is provided in single room accommodation that has been personally decorated and furnished to reflect individual tastes and personalities. At the time of the inspection, all communal areas and the three bedrooms seen by the Inspector were found to be clean, tidy and well maintained. All relatives spoken with confirmed that the home was always clean and free from odour. Darwell House Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Service users benefit from an effective team of staff to support them. EVIDENCE: Darwell House currently has a number of staff vacancies which are in the process of being recruited to. The division of the two units has increased the required staffing ratio and these gaps are being filled in the interim by the use of agency staff and this was reflected on the staff rota. On the day of the inspection, two members of agency staff were working. The Inspector interviewed one of these people, who demonstrated a good knowledge of the service user he was supporting. He confirmed that he had worked a number of shifts at the home over a two year period and was familiar with the way the home operated. He informed the Inspector that he received regular training updates from the agency and understood his responsibilities whilst working at Darwell House. Both units were being run by senior members of staff who had knowledge and experience of the home and service users. The five relatives who provided feedback about the home, said they were happy with the number of staff at the home and found them to be kind and knowledgeable.
Darwell House Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40 & 42 Service users are protected by the management systems in the home. EVIDENCE: The home has a raft of policies and procedures in place which outline Opus Livings’ expectations about the way the home should operate. There was evidence that a number of polices had been reviewed since the last inspection, including the adult protection policy. It was identified that some of the policies were not specific to Darwell House and these should be reviewed to reflect actual practice. The staff on duty demonstrated that they were aware of their responsibilities under Health & Safety. A maintenance person is employed to undertake a variety of checks and audits and to keep the home in a good state of repair. Access to individual training records and audits was not available at this inspection. Darwell House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 3 2 3 Standard No 31 32 33 34 35 Score x x 3 x x
Page 20 Darwell House Version 1.10 14 15 16 17 2 3 x 3 36 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x 2 x 3 x Darwell House Version 1.10 Page 21 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 YA14 Regulation 16(m)(n) Requirement The Registered Person consult with all service users to devise a programe of suitable and fulfilling activities. (Previous timescale of 01 April 2005 not met) Service users access to external day services is not prohibited by the unreliability of house vehicles. (Previous timescale of 01 April 2005 not met) Policies and procedures are reviewed to ensure they refelct current practices within the home. (Previous timescale of 01 April 2005 not met) Risk assessments are developed to include all activities and how the controls in place manage the risk. Timescale for action 01 July 2005 2. YA12 & YA14 16(m)(n) 01 July 2005 3. YA40 24 01 July 2005 4. YA9 13(4) 01 July 2005 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.
Darwell House Version 1.10 Page 22 Refer to Standard Good Practice Recommendations Darwell House Version 1.10 Page 23 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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