CARE HOME ADULTS 18-65
Devonshire Manor 2 Devonshire Road Sherwood Nottingham NG5 2EW Lead Inspector
Stephen Benson Unannounced 8 June 2005 09.30 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. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Devonshire Manor Address 2 Devonshire Road Sherwood Nottingham NG5 2EW 0115 9622538 0115 9856111 stepforward1@btinternet.com Mrs M A Webster Ms J T Ault Mr E Foster Younger Adults 5 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) Category(ies) of Learning Disability - 5 registration, with number of places Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. People accommodated will have suffered a head injury. 2. People accommodated will be aged 18 or over. Date of last inspection 1 March 2005 Brief Description of the Service: Devonshire Manor is a care home providing personal care and accommodation for 5 younger adults who have disabilities resulting from a brain injury. The home provides short and long term care and will provide a respite service and accept emergency admissions. The home is owned by Stepforward (Nottingham) which is run as a family business. The home is located in a residential area of Sherwood close to shops, pubs, the post office and other amenities. The home was opened in 1987 and consists of a domestic dwelling with a small extension to the rear. All of the home’s bedrooms are single, and none of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors. The home does not have a lift. The home has a small tarmac courtyard and there is car parking available for 2 cars with further unrestricted parking available on the road. Further information about the home can be obtained from the manager. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first of two unannounced inspections to be carried out between April 2005 and March 2006. The inspection lasted for 6 hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, care staff on duty and care practices were observed. Other residents were spoken with but no relatives or visiting professionals were seen during the inspection. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. What the service does well: What has improved since the last inspection?
There is a procedure now in place to ensure that any new residents are assessed before admission and the complaints procedure now states how long
Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 6 it will be before any complaint is resolved and all new staff are now checked to ensure they are suitable to work in a care home setting. Areas of the home have been redecorated and some new tiles have been fixed around a wash basin in a residents bedroom. Food is being correctly stored and labelled. 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. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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 Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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, 3, 4 and 5 In future any new resident will be fully assessed prior to admission and arrangements are made for needs and aspirations to be met. The admission process is extended to ensure that the placement is working. EVIDENCE: A resident was admitted prior to the previous inspection without the home receiving a copy of the extended community care assessment and a requirement was set regarding the assessment of new residents. There has not been any resident admitted since, however the manager stated that he would ensure in future that a copy of the assessment was in the home. A copy of this assessment has still not been obtained and one should be. There is an additional assessment form which staff from the home use to assess any new residents. There is a range of information available about services available through the home and these are incorporated into the individual care plans. Residents use physiotherapists, occupational therapists, speech and language therapists and there are close links with the Nottingham City Brain Injury Team. A resident said that he goes to speech therapy to help with his speaking and another said that she was hoping to move on to live independently in the future and is being helped to prepare for this. Staff said that new residents are able to visit the home before moving in and there is then a probationary period to see if the placement is working out. New residents sign and are given a copy of the terms and conditions of the placement and these were seen on the files of those residents who were case tracked.
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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 and 9 Residents are involved in their care plan and these show how their needs are met and they are supported to achieve their goals. Residents are supported to take responsible risks and limited when assessed necessary. EVIDENCE: Care plans are broken down into the following areas: Problem/need, specific agreed overall objective, goals and interventions. There is then a space for these to be signed by a member of staff and the resident. Plans were fully completed and explained the interventions clearly. The residents and staff had signed the majority of plans, but some recent ones had not been. One resident said that she had not seen her care plan and no one had discussed this with her. Her care plan showed that she had previously signed plans but some recent ones had not been. Another resident said that staff discuss his plan with him and staff said that the keyworker reviews plans with residents on a monthly basis. Staff were observed working with residents as described in the plan, examples being one resident’s whereabouts was monitored every half hour and another was reminded to take a mobile phone with her when going out alone. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 10 Plans detailed any restrictions on residents and the reason why. These included use of alcohol, smoking and going out unescorted. Plans also described where residents are known to be aggressive or not tell the truth, behaviours that are bought about due to their conditions. Although the plans seen contained a considerable amount of information they were somewhat disorganised making it more difficult than need to be to use the plans. This was discussed with the manager who agreed it would be of benefit to organise plans better and it is recommended that this be done. There is a system for carrying out a comprehensive programme of risk assessment and these include supporting residents to take responsible risks and to make decisions about what they are able to do. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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) 12, 13, 15, 16 and 17 Residents have appropriate individual daytime programmes and are actively involved in the local community. Support is provided to maintain family contact and residents are involved in planning and preparing their meals. EVIDENCE: Each resident has a weekly planner in their care plan listing how their time is spent. Those planners seen included attending college, a community centre and doing voluntary work. The manager said that staff try to create a working 9 to 5 mentality. One resident said she enjoyed being able to go out to work and loved her job at the charity shop. An appointment has been made for one resident to see the disability employment advisor to help identify some suitable employment. One resident had a basic food hygiene certificate he had achieved displayed in his room and said he now had a total of 13 certificates. Residents use a variety of resources in the local community including local pubs, shops, and transport. A resident said she enjoyed the karaoke at a local pub and likes to sing a Madonna song. A member of staff was seen making a hair appointment at a local hairdresser. The manager said that they have now got a regular arrangement with a local swimming pool where the pool staff
Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 12 give up some of their lunch break to supervise the residents using the pool. There are also trips to the cinema and other entertainment centres. One resident said he was a Nottingham Forest supporter and he had been to watch them play several times last season. Details of contact with family are in care plans and residents are supported to go to visit their families. One resident said she had gone home last weekend and staff said that residents can and do have family and friends visiting them, but suggest they arrange this first so that they do not clash with any planned activity. A member of staff accompanied a resident on a planned visit to his mother during this inspection. Residents are encouraged to be as independent as they are able to. One resident said she wants to leave to live in a flat or bungalow and that she is doing her own washing, shopping and cooking to help her manage this. Staff said that residents are supported according to their ability to clean their rooms and everyone washes up their own plates. Staff and residents were seen talking at ease and joking with each other. The menu is prepared weekly with residents all choosing a meal. There is some guidance given for a healthy and balanced diet with chips being limited to once a week. The resident who wishes to live independently is responsible for planning her own menu. Other residents are encouraged to cook and one resident has an adapted chopping board to enable him to prepare food to cook. The resident said he likes to make a curry. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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 and 20 Residents are supported to be as responsible as they are able for their own personal care and their healthcare needs are met. EVIDENCE: Details of the abilities of residents to attend to their own personal care are included in care plans as well as listing where support is required. One resident said that he needs some assistance to shower and he is happy with how staff provide him with this support. Staff described good practices in maintaining residents’ privacy and dignity. Records showed that residents have access to a range of healthcare services, however the record made is in the daily notes, making it difficult work out when residents are due for another service. A separate record would make it easier to see when a new appointment is due. One resident complained of a painful toe and staff gave advice on the best shoes to wear until she could get to the doctors. This lead to a discussion between staff as to whether the resident or staff should make the appointment and it was felt that the resident should start being supported to manage her own healthcare in preparation for her future. The storage of medicines was well organised using a monitored dosage system and medicine administration sheets were fully completed. Only staff who have
Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 14 been trained in the safe administration of medicines are able to administer them. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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 and 23 A more active approach to the complaints procedure is needed. Staff are aware of their responsibility in safeguarding residents. EVIDENCE: There is a complaints procedure in place, which has been amended, following a requirement set at the last inspection, and a book to record complaints in. The manager said that there have not been any complaints received. Following a discussion about the positives of an effective complaints procedure the manager felt that he could develop the use of the procedure within the home. A resident complained that she gets annoyed by other residents continually flicking the television channel over with the remote control. This was passed onto the manager and should be dealt with through the complaints procedure. The manager has applied to go on adult protection training and is waiting to hear if he has been accepted. The adult protection procedures were in the office and there is a whistleblowing policy. Staff said they were familiar with the procedures and have had experience of using them. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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 and 30 There is a homely atmosphere in the majority of the home but this does not extend to the rear extension and the laundry is not suitable for use by residents. EVIDENCE: The building provides comfortable accommodation that is well maintained and decorated although some exterior paintwork requires attention. The small extension to the rear contains the exit to the courtyard area and the smoke room, with the payphone in and a door leading directly into the staff toilet. This arrangement is far from satisfactory as the room is very smoky which is particularly unpleasant for anyone using the payphone and offers little privacy to staff using the toilet. Residents were seen sitting on dining chairs in the courtyard as there was no seating provided. The handyman based at the provider’s other home in Mansfield carries out maintenance, which is recorded in a repairs book. The home is kept clean by staff and residents. The laundry has a low ceiling and is located in the cellar. This is difficult to access and only residents who have been assessed as being able to reach it safely are allowed to use it under supervision from staff.
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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) 34 and 35 Correct recruitment practices are followed to ensure that appropriate staff are employed to work with residents an d the required training is provided. EVIDENCE: The recruitment of new staff requires applicants to complete an application form and attend for interview. Successful candidates are then required to undergo a Criminal Records Bureau check and references are taken up. Staff are provided with statement of terms and conditions and a copy of the code of conduct and practice issued by the General social Care Council. Staff training records and a training profile are held on each staff file. Those seen all had the required mandatory training. Staff felt that as part of their work requires them to use the computer they would benefit from some IT training. One resident said that he had done the basic food hygiene course with staff. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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) 37 and 39 The manager would benefit from a managerial qualification. There are systems for seeking views of others need to be actioned. EVIDENCE: The registered manager is a qualified nurse, however he does not have either the Registered Manager Award or National Vocational Qualification level 4 in management. The manager will be required to have one of these qualifications by the end of this year and it is recommended that the manager enrol on one of these courses now. The home has achieved Investor in People status and there was a copy of the last inspection report displayed in the smoke room. Staff have completed a quality assurance questionnaire and there is a format prepared ready for residents and relatives but this has not yet been given to them to complete. The registered provider visits the home regularly does not complete a report as required by Regulation 26 Care Standards Act. Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 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. 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 2 3 3 3 Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Devonshire Manor Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x x x C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 14 Requirement Obtain a copy of the extended community care asessment for the most recently admitted resident Ensure that complaints made are addressed threough the complaints procedure Review the current layout/use of the rear extension Decorate external paintwork where needed Provide seating for residents in the courtyard area The provider must prepare reports as detailed in regulation 26 Seek the views of residents and relatives on the serivces provided Timescale for action 1st July 2005 1st July 2005 1st September 2005 1st September 2005 15th July 2005 1st July 2005 1st August 2005 2. 3. 4. 5. 6. 7. 22 24 24 24 39 39 22 23 23 23 26 24 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
C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 21 Devonshire Manor 1. 2. 3. 4. 6 19 35 37 Keep care plans in an organised manner Keep a separate record of healthcare appointments Provide staff with information and technology training The manager should enrol onto either the Registered Managers Award or National Vocational Qualification 4 in management Devonshire Manor C53 C)3 S2196 Devonshire Mnr V231863 080605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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