Inspection on 06/12/05 for Derriads

This inspection was carried out on 6th December 2005.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Derriads 21/01/09

Derriads 16/07/08

Derriads 01/05/07

Derriads 27/06/06

Derriads 16/06/05

Derriads 27/01/05

Derriads 15/09/04

Derriads 24/03/04

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 Derriads Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL Lead Inspector Alyson Fairweather Unannounced Inspection 6th December 2005 3:00 Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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 Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Derriads Address Respite Care Home 70 Derriads Lane Chippenham Wiltshire SN14 0QL 01249 652814 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) Wiltshire County Council Vacant Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 4 service users with learning disabilities, or learning disabilities, over the age of 65, at any one time. 16th June 2005 Date of last inspection Brief Description of the Service: Derriads is an extended bungalow situated in a quiet residential area on the outskirts of Chippenham. The home provides respite care for up to four service users at a time, who have severe physical and learning disabilities. The home is owned and managed by Wiltshire County Council. The manager and staff team also run Meadow Lodge, which is part of the Chippenham Respite Service. There is 24 -hour staff cover to provide support for service users. Derriads is an attractive home, with a large lounge and comfortable furnishings. There is a separate dining room, a kitchen and two bathrooms, one with an assisted bath. There are four single bedrooms, all with wash hand basins and ceiling tracks for hoists. To the rear of the house is a large, secluded garden which is accessible to the service users, with aromatic plants and attractive features. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon and evening on 6th December 2005. There were three people using the respite unit, all of whom were at home in the evening. The two deputy managers and three care staff were all spoken to. The inspector walked round the premises and examined several records, including care plans, risk assessments and staff training. What the service does well: What has improved since the last inspection? What they could do better: The providers of the service at Derriads are Wiltshire County Council. As part of their responsibilities, a regular monthly visit by one of their representatives should be made, and a copy of their report should be sent to the CSCI. At the last inspection this had not been done, and a legal requirement was made that the provider must fulfil their obligation. The dining room windows have old metal frames, with chipped paint and cracked window sills. Staff reported that this window suffers badly from condensation. Again, a requirement was made that this should be repaired. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 6 Neither of these two requirements had been met, and have been repeated at this inspection, with a date set for when they must be met. Legal requirements are made at an inspection if it is found that there is any breach in the way which the providers manage the home, and a date is set whereby these requirements must be met. CSCI takes very seriously any failure to meet these requirements, and enforcement notices may be served on any provider who fails to meet requirements. 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. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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 Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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 the following standard(s): 1 Prospective service users do not have enough information to make a choice about whether they would like to stay in the home EVIDENCE: The home has a statement of purpose and a service user guide, which give details of the service offered, the staffing and management arrangements and the scale of fees. However, the management of the home had changed since the document was written, and now two deputy managers oversee both Derriads and Meadow Lodge. At the last inspection, it was recommended that the Statement of Purpose should be amended to reflect the changed management arrangements. This had not been done, with the result that the document remains misleading. The registered person has been asked to ensure that the home has an accurate Statement of Purpose in place. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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 the following standard(s): 6, 7 and 9 Care plans did not reflect the needs of all respite service users. They are assisted where necessary to make decisions about their own lives, and are supported to risks as part of an independent lifestyle. EVIDENCE: Care plans were in place for all respite service users. Each service user has a support plan which is drawn up prior to their stay, and is compiled with the help of their families. These include details of any personal care needs, medical and physical health, mobility and communication skills. The support plans also highlight people’s likes and dislikes, and is entitled “All About Me”. One service user had a plan in place which stated that the bedroom door should be locked for short periods at night, to stop her from coming out of her room. Staff on duty reported that this was seldom used, as it was felt to be unnecessary. The registered person has been asked to seek an immediate care review with the CTPLD. If this practice is endorsed by the medical team, this should be clearly recorded in a care plan and agreed by all present. Another service user used bed sides, and again there was no multidisciplinary team agreement for their use. In discussion with staff, it was clear that this was for the service user’s safety, but staff also were aware of the risk of this practice being used as a method of restraint, and being used punitively. The registered person must Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 10 ensure that reviews are sought regarding the use of bed sides for all those people to whom it applies. Service users are supported to make decisions about their own lives with guidance from the staff. The interaction observed between the service users and staff showed clearly that staff were aware of service users’ wishes. People are encouraged to manage their own finances wherever possible. Where restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. Risk assessments were on file for all service users, and these are reviewed annually, unless there is a need to do otherwise. These included things like transferring from a wheelchair, eating and drinking, bathing and moving and handling. Staff place great emphasis on encouraging service users to be as independent as possible, while trying to minimise any risk to their safety. There is a complicated system of scoring risks, with some scores seen as acceptable risk taking. Scoring is done by allocating a number to the severity of the risk, adding a number to the likelihood of the risk occurring and multiplying the two scores, giving the “risk rating”. Staff reported that the aim is to reduce the “risk rating” to 1. Severity of risk was rated 1-3, with 1 being slight and 3 being major, for example death or fracture. However, whilst examining several risk assessments, it became clear that this was causing confusion for staff. There was one example where the severity of a scald/burn was rated as a 1. Another, talking about the potential for death during an epileptic seizure, was also rated as a 1. If this risk assessment method is to be used by staff, clear guidance and training must be given about the use of the scoring system. The registered person must ensure that all risk assessments are accurately completed. The form also described “slight severity” of risk as “ injuries where persons may be off work for less than 3 days”. It would appear that this risk assessment is more appropriate for use with people other than service users, and it is recommended that serious consideration should be given to introducing one more suitable for service users with disabilities. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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 the following standard(s): 16 Service users’ rights are respected and responsibilities recognised in their daily lives. They are offered a healthy diet, with their preferences taken into account. EVIDENCE: Service users can choose when to be alone or in company, and when not to join in an activity. Staff enter service users’ bedrooms only with the individual’s permission, and were seen to knock on the bedroom door before entering. Daily routines are flexible, with people choosing what they want to do when they return from day services. Some family members have commented that if there were more staff on duty there might be an opportunity for more activities for service users. Staff said that the home is currently recruiting for two care staff and a manager. Service users have unrestricted access to the home and grounds, and can come and go as they please. Discussion was held with staff about the presence of a CCTV camera in one of the bedrooms. It was stated that this was only ever used for one particular service user who had now gone to live in residential care and was unlikely to use Derriads again. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 12 Staff were clear that this was only ever used for one person, but were reluctant to remove it in case the service user had to return. However, other service users use this room, and the presence of a camera must be seen as an unacceptable intrusion into the privacy of their bedroom. The registered person must therefore ensure that the CCTV is camera in the bedroom is removed. If the service user is to return, and is said to need the use of CCTV in her room, then the agreement of a multidisciplinary team must be recorded and stored on the care plan. The menu supplied in the home is varied and nutritious, and is drawn up on a weekly basis. Breakfast usually consists of cereal & toast, lunch can be a cooked meal for those who wish, or a packed lunch for those who go out during the day. The main meal of the day is at supper time, and is centred round the likes of the people staying in the home on a daily basis. Supper on the day of the inspection consisted of chicken in white sauce, broccoli, carrots and new potatoes. There was a good supply of fresh fruit and vegetables, and juices and yoghurts were also available. Staff have records of the food likes and dislikes of all service users, and of any feeding support necessary. One service user was using a plate guard and small spoon. Diabetic diets were also available, and staff were clearly aware of the various diabetic options. Several positive comments were received by families about the quality of the meals. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 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 the following standard(s): 19 Service users’ physical and emotional health needs are met. EVIDENCE: Derriads has various adaptations and pieces of equipment in place to help with service users’ physical needs, including hoists and wheelchairs. All service users have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment and from occupational therapists. If the families live locally, the person’s own GP is used, and there local GPs are used for those who live further afield. Medical professionals are seen as and when required. This varies according to the needs of individuals and the situations arising while having respite care. The home has good links with the local learning disability teams, which enables an effective response to any crisis periods that may arise. All service users attend reviews on a regular basis, and the care plan may be amended at this time. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 14 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 Service users’ views are listened to and acted on. EVIDENCE: There is a complaints procedure which outlines the steps to take if there are any complaints, and all service users get a copy of this. It also gives details of how service users and families can contact the Commission for Social Care Inspection (CSCI). A complaints book is kept in the office, and any complaint would be recorded there. No complaints have been received either by the home or to CSCI. One relative responded positively, saying “I have no complaints about Derriads. I am happy for my daughter to go any time. She is happy there, and I have no worries at all”. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 15 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 and 30 Overall service users have a comfortable home, although the attractiveness of the environment is let down by the poor state of the windows. The home is clean and hygienic, although one carpet was stained. EVIDENCE: Derriads is an attractive bungalow, with level access throughout the home, and a ramp up to the front door. Care staff look after the general household cleaning and chores. The lounge is a large, comfortable room, and has some sensory equipment in one corner. The kitchen is bright, and cheerful, with a stable type door to the kitchen, so that service users can be safe whilst staff are occupied cooking. The dining room windows have old metal frames, with chipped paint and cracked window sills. Staff reported that this window suffers badly from condensation. This windowsill must therefore be repaired or replaced. The carpet in bedroom 3 was badly stained, although it has been cleaned recently. This carpet must again be deep cleaned or replaced. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 16 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 34 Service users are supported by competent and qualified staff, and protected by the recruitment procedures used by Wiltshire County Council. EVIDENCE: All new staff receive induction training, and have also started using the Learning Disability Award Framework (LDAF) to assist their training, which means that the needs of service users with learning disabilities will be more fully understood. There are currently five staff undertaking NVQ Level 3 and five who have completed it. One has also completed the Work Place Assessor award. All staff have mandatory training which includes medication, manual handling, first aid, food hygiene, basic health and safety and risk assessment. Wiltshire County Council offers staff a wealth of training opportunities, and these opportunities are discussed and agreed at supervision sessions. The staff team at Derriads also work at Meadow Lodge, another Chippenham respite service. Staff on duty reported that they had to rely heavily on agency staff at the moment, and that the home was currently recruiting for more care staff. Wiltshire County Council’s employment checks include Criminal Records Bureau (CRB) checks, two written references and a medical declaration. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 17 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): Service users’ views, and those of their families, underpin the monitoring and review of care practice. EVIDENCE: All families are visited on an annual basis, and other contact is made by telephone and letter. A “Friends of Derriads” group has been set up, and a questionnaire has been sent out to service users and families. The home should give consideration to formalising a response to the questionnaire, as currently this is not done. At the last inspection the provider was asked to ensure that regular monthly visits to the home were conducted, and a copy of the report of these visits sent to the CSCI. This had not been done, and therefore this has again been made a requirement. Staff were reminded of the seriousness of failing to meet legal requirements Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Derriads Score X 3 X X Standard No 37 38 39 40 41 42 43 Score X X 2 X X X X DS0000032436.V266791.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation 14 Requirement The registered person must ensure that the home has an accurate Statement of Purpose in place. The registered person must ensure that a review is urgently sought for the service user whose care plan endorses locking the bedroom door. The registered person must ensure that reviews are sought regarding the use of bed sides for all those people to whom it applies. The registered person must ensure that all risk assessments are accurately completed. The registered person must ensure that the CCTV camera in the bedroom is removed. The window sill in the dining room must be repaired or replaced. Comment: This is the second time this requirement has been made. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 20 Timescale for action 06/02/06 2. YA6 15 (2) (b) 13 (7) 20/12/05 3. YA6 15 (2) (b) 06/01/06 4. YA9 13 (6) 06/01/06 5. 6. YA16 YA24 12 (4) (a) 23 (2) (b) 20/12/05 06/01/06 7. YA24 23 (2) (d) The carpet in bedroom 3 must 06/01/06 be deep cleaned or replaced. Comment: this carpet has been cleaned, but is still badly stained. The registered provider must ensure regular monthly visits to the home and must provide a copy of the report of these visits to the CSCI. Comment: This is the second time this requirement has been made. 8. YA39 26 06/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA9 YA39 Good Practice Recommendations Serious consideration should be given to introducing a risk assessment format which is more suitable for service users with disabilities. The home should develop a formal response to the questionnaire sent out to service users and families. Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Derriads DS0000032436.V266791.R01.S.doc Version 5.0 Page 22 - 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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