Inspection on 04/01/08 for Darwell House

This inspection was carried out on 4th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Darwell House 22/12/08

Darwell House 26/06/07

Darwell House 24/10/06

Darwell House 07/06/06

Darwell House 28/10/05

Darwell House 23/04/05

Darwell House 29/11/04

Darwell House 26/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Darwell House Grange Court Maynards Green East Sussex TN21 0DJ Lead Inspector Geoff Senior Unannounced Inspection 4 January 2008 10:15 th Darwell House DS0000021117.V353191.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 Darwell House DS0000021117.V353191.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. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Darwell House Address Grange Court Maynards Green East Sussex TN21 0DJ 01435 866468 01435 867519 darwell@evesleighcaregroup.co.uk springmeadow@ilg.co.uk ILG Ltd 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) Vacant Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is fifteen (15). Service users will be aged between eighteen (18) and sixty-five (65) years on admission. Service users will have learning disability as their assessed primary need. 26th June 2007 Date of last inspection Brief Description of the Service: Darwell House is registered for fifteen adults with a learning disability. The home is a large, two storey, detached property. There is a large amount of communal space, separate kitchen and dining facilities and sufficient bathrooms and toilets. The service stands alongside its sister home [Springmeadow], in several 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. Information on the current range of fees charged is normally within the home’s statement of purpose/service user guide with fees described as approximately ranging from around £950 to £1150 per week. Extras charged are for personal items. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit took place on 4th January 2008 between 10:15 am and 4:15pm. The manager, Mr. Kevin May, people who live at the home and staff assisted with the process. Two inspectors carried out the site visit, and were made welcome. Four people live at the home at the moment. A variety of surveys were sent to the manager to distribute. Four were returned from service users, three from relatives and one from staff. We spoke briefly to all residents who were able to give various degrees of feedback. Some comments received or indicated by service users were, - they were pleased to live at the home, things had improved since some other residents had moved on and the new manager had arrived, they liked the staff, going out on activities and their environment. The manager and, one resident or another, showed us around their home. The manager pointed out where changes are planned, where maintenance was needed and where improvements had taken place. The inspection process consisted of information collected before, during and in the few days after the visit to the home. Some of the information seen was assessment and care plans, medication records, duty rota, health support plans, policy on restraint, training information and staff records. What the service does well: The home is set in spacious grounds that are safe for people to use without accompaniment. The home is in good condition and there is good maintenance support, which means that things do not remain broken or out of order for long. There is a broad range of training given to the staff team. This has been reviewed, and the manager has a say in what training is needed, based on service users’ support needs. There is a range of activities to do. Many of them are based on the home’s own grounds and focus on horticulture. Some take place in the community, like swimming, shopping and going to the library. People are encouraged to do their own laundry and personal housework with support. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 6 The staff are friendly and some have known the people living at the home for a long time. This has helped them build trusting relationships. What has improved since the last inspection? What they could do better: Care support plans have improved, but do not say what the person is good at or what their strengths are. Because the home has not fully implemented a ‘Person Centred’ approach to planning its not clear if the support people get is what they have agreed. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 7 Goal plans are in place, but like above, its not clear if these are the goals people actually want. 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. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 8 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 Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 9 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): 2,3,4. Quality in this outcome area is adequate. The manager has revised documentation to more accurately reflect the current service and its intended direction. Any potential occupant would be subject to assessment to ensure their needs and aspirations could be supported and the placement would be mutually beneficial. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager reports, in his revision of the Statement of Purpose, that Darwell house has undergone a number of changes over the past few months. This has been in response to the CSCI requirements, recognition of incompatibility issues and the service, as it was, not being able to meet some service users’ needs. The number of service users resident in the home has been reduced and the property adapted to better suit the remaining service users’ needs. Since the changes were implemented there has been a period of time for establishing consolidation. The home has not had any new admissions for some time. Although registered to accommodate a maximum of 15, the Manager said that the Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 10 preferred maximum would be 8 with the additional space being put to other use. The reduction in numbers has not been formally agreed with the organisation. The referral, assessment and admission process was described. It is planned to use a person centred planning approach to assessment, involving relatives, carers and the individual service user. Visits to the home and involvement in activities would offer the opportunity to meet and spend time with the existing service users and staff, view the accommodation and learn about the lifestyle they could expect to experience at Darwell. Existing service users would be invited to offer their views about a potential new admission. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 11 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 adequate. Service user plans state what support a person requires but need to be developed to seek and record the individual’s point of view. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was noted in previous reports that the organisation had appointed a consultant to review the care planning process and address the identified shortfalls. Four service user files were viewed; each person was seen to have a care and support plan with long-term goals and criteria for success. The goals are in teaching steps, which have been reviewed by the manager, and steps removed or altered. The service user plans were written up with input from consultants. They broadly support people in a positive manner but do not show the input service users have had. They are not easily accessible in that they do not use pictures or use a person centred approach. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 12 Some aspirational goals are now being developed such as travelling on public transport and using their own computer. There needs to be more evidence that people have chosen the goals and that they really are a focus for their life. The Manager indicated that he is fully aware of the need and is intending to develop Person Centred Planning but is currently adhering to the Organisation’s pilot scheme plans. The daily records give staff only limited space to write the report. Thus they tend to describe the basic activity but not what the person actually got out of the day. The manager acknowledged the need for space and detail. Decision making around the house is actually much better in practice than is represented in the care plans and records. People are, for example, choosing what bedroom they would like to have, how to decorate it, what activities they want to undertake, making snacks and drinks and getting involved in the dayto-day household chores. Risk assessments have been reviewed and endeavour to enable the service users to be more independent. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 13 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. Service user rights and responsibilities in the every day lifestyles are acknowledged and respected. They have opportunity to actively participate in the decision making process relating to the routine and lifestyle they experience at Darwell. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are working positively with the service users to establish likes, dislikes and interests. They are supported by the Organisation to provide a range of activities and events for recreational and therapeutic purposes. The goal plans were devised by consultants and were expected to be used without revision for a six-month period. The Manager has however initiated slight changes so they are more relevant to the individual. One service user was refusing all educational courses until he was given time to sit with staff and discuss what he really wanted to do. He now takes part in animal welfare and music Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 14 courses. One of the support workers runs a well supported cooking group and plans to extend to offering day care groups in horticulture and gardening. The Manager intends to attend a ‘training the trainer ‘ course in Eastbourne relating to active support (skills training for individuals). This would help develop service users participation and involvement in everyday activities that may traditionally be seen as staff tasks (laundry and cooking). Service users’ rights to privacy are respected at all times and the have unrestricted access to their private space. Service users choose the colour of their door and each have their own key. Contact with family and friends is encouraged and enabled. Family feedback on survey forms generally confirmed that staff keep in touch to report and update on any notable issues. One problem, about getting an answer on the phone, has been resolved to everybody’s satisfaction. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 15 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 adequate. People have their health and personal care needs met but need more support towards maximise independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are treated with dignity and respect and levels of privacy are maintained. All the service users require some assistance with aspects of personal hygiene and care. The Manager endeavours to ensure that the staff are instructed and supervised to provide this thoughtfully and sensitively. The health needs of the service users are monitored and addressed. It was reported that the home has developed positive relationships with the local health care professionals who provide a good level of support. The medication records and storage facilities were seen and reported as being adequate for the needs of the home. Records were clear and up to date. The Manager reported that he is satisfied that the staff members involved with Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 16 medication have undertaken training and satisfied competency assessments. Supported self-medicating and storage in own rooms was discussed as a potential move in the future once other issues have been resolved. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 17 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 adequate. Service users are supported, individually and as a group, to understand the complaints procedure and how and where to express dissatisfaction if they are unhappy. Staff training and the policy on restraint is to be reviewed by the manager to ensure that service users are safely supported and protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager indicated a clear understanding about resolution of complaints through the Organisation’s complaints procedure and of adult safeguarding protocols. He reported a good relationship with the local safeguarding team and an understanding of how reporting systems work. Records of incidents are maintained and passed on as required. There was no evidence of environmental restrictions. Apart from the unused part of the house, service users may come and go as they please within and outside the premises. Records are kept and personal monies accounted for. Service users have their own bank accounts. Residents’ house meetings provide a forum for explaining, and making real, the complaints policy. A text policy is displayed. This is soon to be Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 18 replaced by a pictorial one. Service users are encouraged to approach the Manager or staff to talk about any issues of concern to them. The office door is open and service users were observed coming and going without inhibition or restriction. The policy on restraint was discussed with the manager as it was the subject of requirement in past inspection reports. It does not clearly define what restraint is in any of its contexts or indicate to staff what action to take if they find themselves in the situation of restraining a person. The Manager agreed to review without delay and ensure that staff training and the policy are current and appropriate. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 19 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. Darwell provides a varied and comfortable environment in which to live and work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently registered to accommodate a maximum of 15 service users. At the time of the visit there were 4 in residence. The manager reported that it is unlikely that the occupancy will exceed 8. Vacant rooms on the locked upper floors and wings may be utilised for training and a training kitchen. The parts of the house used by staff and service users appear to be well maintained and in good decorative order. Bedrooms viewed in company with the occupant were highly personalised, decorated according to personal choice and the service users may have their own bedroom door key. One service user Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 20 proudly showed off his “lovely new room” that he was about to move into and had been painted in the colour of his choice. There is adequate communal space accessible to all and comfortably furnished. There are also areas where service users may seek solitude if they wish. One service user was keen to show the pictorial rota on display, which he updates, to show who is supporting them for the day. Externally the extensive grounds have areas for recreation, horticulture and animal husbandry. Staff and service users were keen to point out a small tree planted in memory of a fellow service user who had recently passed away. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 21 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): 32,34,35. Quality in this outcome area is adequate. Sufficient numbers of staff are on duty at all times to support service users. The safety and welfare of residents is promoted because of the home’s sound recruitment procedures and staff development programmes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was reported that, whilst service user numbers remain at four, there will be at least three members of staff on duty throughout the day and two on the premises at night. Mr May the Manager works across the whole range of duty hours. An activities co-ordinator works on site during the day. A training matrix showed at a glance what training had been completed by staff and where gaps lie. At least ten staff have completed NVQ to level 2 or above. Additional service specific training has been attended or is planned for the future. Mandatory training is up to date. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 22 Staff were observed interacting with service users and responding in a friendly, respectful and non-patronising manner. Service users joined staff in completing household tasks such as shopping for, and putting away, the weekly provisions and kitchen tasks. Staff were also seen sitting with service users in the lounge quietly interacting and, in the case of one service user, having a head massage. Staff recruitment procedures are robust. Appropriate checks are undertaken prior to appointment and commencement of duty. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 23 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. The manager is endeavouring to ensure that the home is run in the best interests of the service users. The health, welfare and safety of all is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager presents as an experienced and well informed individual. He has, in a relatively short period of time, fostered and open and positive ethos in the home enabling service users, staff and relatives to feed back about the service. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 24 Monthly monitoring visits to the home are carried out by senior managers, ensuring that the standard of care and documentation is maintained and the premises are in good order. These visits by the registered provider focus however, on systems and management issues, rather than assess what lifestyle people are experiencing. The manager reported that people who use the service have been given ‘service user feedback forms’ to complete along with relatives who had also completed and returned Quality assurance questionnaires. The Manager confirmed that Health and Safety matters, certificates and checks are all up to date. A fire alarm check and staff re-induction to the fire procedure was observed as taking place during the visit. Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 25 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 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 3 x Darwell House DS0000021117.V353191.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15 (1)(2) Requirement Standards 6, 7, 9, 12, 13, 15, 16, 17 So that all service users have a say in what they want out of their lives, a system of consultation (person centred planning) in a way that is accessible to each individual must be developed. This should have a direct feed into risk assessments, necessary support strategies and the quality assurance systems. This requirement combines previous outstanding requirements which have been partly met from timescale for completion of 26/9/07 So that service users are protected staff must have clearly written behavioural support guidelines to follow that have had multi-agency agreement. The policy on restraint must be fully reviewed to protect the service users and support the staff to work within the law. DS0000021117.V353191.R01.S.doc Timescale for action 01/04/08 2 YA23 12 (1, a, b; 3), 13 (4, b, c) 17 (1, a; 3,a) 01/04/08 Darwell House Version 5.2 Page 27 3. YA39 24 So improvements to the 01/04/08 service are meaningful to the lifestyle of the service users, an accessible quality assurance and monitoring system based on service user and stakeholder views must be implemented. An annual development plan that indicates the steps to achieve improvement or development is kept under review, and, where meaningful, service users kept up to date on its progress. The quality assurance system should be linked to individual service user person centred plans and lifestyle goals. Requirement of the last 4 inspections. Requirement first made November 9, 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. Refer to Standard YA20 Good Practice Recommendations That any possible changes to medication of service users are carefully reviewed and involve independent advocates and at least the service user’s care manager. So service users have the maximum benefit from person centred planning and the impact on quality assurance, staff should receive input that is relevant to improvement, such as ‘Person Centred Planning’, ‘Active Support’, DS0000021117.V353191.R01.S.doc Version 5.2 Page 28 2 YA35 Darwell House communication techniques and ‘Empowerment’ type training. 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