CARE HOME ADULTS 18-65
Donna Claire Venture Short Break Service Donna Claire House 6 Seaburn Terrace Seaburn Sunderland SR6 2BZ Lead Inspector
Elsie Allnutt Unannounced Inspection 15th February 2006 10:00 Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Donna Claire Venture Short Break Service Address Donna Claire House 6 Seaburn Terrace Seaburn Sunderland SR6 2BZ 0191 529 3171 NO FAX 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) Miss Geraldine Plunkett Care Home 6 Category(ies) of Physical disability (6) registration, with number of places Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th September 2005 Brief Description of the Service: Donna Claire Venture is a short break service operated privately by two people, Geraldine Plunkett and Audrey Turnbull. The service provides planned breaks for both men and women with physical disabilities, between the ages of 18 and 65 years, and who are dependent upon carers for care and support. The level of service provided depends on the needs of the individual. Donna Claire is situated close to the sea front and within easy reach of a range of shops and other services. The house is a large 2 storey detached building with a bungalow annexe within an area of private housing in Seaburn. It has space and facilities to accommodate people who use wheelchairs and provides 4 single bedrooms and 1 double, now used as a single. There are adaptations and equipment to meet the needs of people with physical disabilities. The aim of the service is to deliver a service as near to a holiday experience as possible, as well as providing a respite period to their carers. During their stay people are supported by staff to take part in community based activities. A garden and patio is also available for the people using the service. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took 3.5 hours over one day in February 2006. The people who use this service prefer to be referred to as guests rather than service users. This will be respected throughout this report. The views of five guests and six members of staff were sought on the day. As not all of the guests have verbal communication their satisfaction of the service was interpreted not only through speech but the observations of body language, interaction with staff, discussions with staff and the examination of records. This process demonstrated that all were satisfied with the service and the care and support given by staff. Several guests were able to give an explicit account of their life while staying at Donna Claire and one guest commented, “I love it here the girls are lovely and I enjoy going out with them.” another commented,” I like coming here because I can be me and do the things that I enjoy.” As part of the inspection process the service users’ care files, a sample of the homes records and areas of the building were examined. What the service does well:
This service provides accommodation of a good standard. It is well maintained and as a result of effective cleaning routines offers a clean and hygienic environment. The inside walls of the home are decorated with attractive paintings and craftwork, which have been skilfully produced by people who have used the service and friends of the home. These offer an added attractive focus for people staying at the home while promoting the skill and abilities of the creators of the work. The gardens that surround the building are well stocked and maintained and provide attractive areas for guests to look on to or relax in. The manager stated that guests and people passing often comment favourably about the abundance of colour in the summer. The walls surrounding the garden currently display a variety of crocus and snowdrops. The friendly interaction of guests and staff create a warm and welcoming atmosphere in the home. One guest commented, “You are always welcomed so warmly, you are never without a laugh.” The kitchen/dining area includes a dining table that accommodates both service users and staff together providing a focus where a mixture of serious discussion and light “chatter” combined with positive humour takes place. Here service users are given the appropriate amount of time and support to take part in discussions about the service delivery and any planned activity. It is an area where the rights and equality of the service users are positively promoted. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 6 The manager and staff ensure that full information in relation to guests care needs is received from the service users, their main carers and other professionals involved in their care, prior to their stay. This ensures that the appropriate resources can be put in place prior to their arrival and the needs of guests are fully addressed in the way that they prefer and are used to. One service user commented, “When I arrived my room was set up the way it is at home.” During discussions with the manager and staff it was established that good relationships have developed between Donna Claire and community health services. Nurse Specialists for example in relation to Parkinson’s and Huntington’s disease have delivered talks to staff about the diseases and have equipped staff with important knowledge and advice which guide them in appropriate care practices that benefit service users. By observing life in the home it was evident that guests are supported to live a full and active lifestyle. Staff work in a lively way with respect and skill and involve guests in making their own choices about what they preferred to do. Care is taken to explain to guests how they are to be assisted with personal tasks making sure that it is the individual’s preferred way. The manager also ensures that enough staff are on duty to give one to one attention when going out on activities. The manager stated that this enables guests to receive quality time and the attention they need. What has improved since the last inspection?
Since the last inspection as a result of a guest having been admitted to hospital by a GP against their will, the manager has addressed the issue with the Health Authority. So that service users’ rights are addressed and their choice not to be admitted to hospital if their condition deteriorates while staying at Donna Claire is respected, the manager has negotiated an agreement with the Director of Nursing at the local hospital in relation to this issue. The manager can now contact the “Urgent Care Team” directly who will assess the situation and depending on their decision will provide the relevant care in Donna Claire resulting in no admission to hospital. So that people using this service are fully protected from abusive situations and staff are aware of what procedures to follow if an allegation of abuse takes place, the manager has addressed this issue with staff and arranged for extra training to take place in relation to the Local Authority’s Adult Protection Procedures. All staff have now received training in moving and handling, this ensures that staff have the skills to move and handle service users in a comfortable and safe way, both for themselves and the service users, while also addressing current legislation. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 7 The toilet on the ground floor has been decorated since the last inspection bringing the décor up to the standard of the rest of the building and providing an attractive environment for service users. 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. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 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 Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards assessed on this occasion. EVIDENCE: Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 10 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): 6,9 Care plans reflect the assessed needs of the guests and they demonstrate how any risks evident when undertaking daily care tasks or when assisting to develop individual lifestyles, are safely addressed. EVIDENCE: Care plans reflect that guests assessed needs are met and their rights and independence are promoted. To ensure a consistent approach to the care of individual guests, clear guidelines are in place in relation to how their care is delivered. Although all of the guests using this service have different needs and vary in age, guests’ individual difficulties are evident and recorded appropriately. This has been achieved by developing the care plans from information collated prior to the guest staying at the service. One service user confirmed that their needs had been addressed prior to arriving at Donna Claire and the necessary resources needed to maximise their independence had been put in their room. A special mattress had been placed on the bed, this they explained ensured their comfort during their stay. The needs expressed by the guests reflected the content in the records examined.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 11 Staff confirmed that service users are supported to take part in as normal a life as possible and the risks that may be involved in doing this are addressed and risk management plans put in place. These are an integral part of the care plan. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 12 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): 14,16 Although the people who use this service often have complex needs their right to choice and to live a normal and active life as possible while staying at Donna Claire Venture is successfully promoted. EVIDENCE: Staff were observed busily supporting guests to get ready for their day’s activities discussing with them the order of the day. Positive and respectful interaction was observed between staff and guests with conversation being directed openly towards the guests. Guests enthusiastically discussed the varied activities they enjoy while staying at the service and how they are supported to take part in them. One guest said, “Staff look after me well and do things the way I like them done.” Another said “ I love coming here, it’s good to have other women to talk to, I don’t get out at home much because I can’t get on the buses or into shops easily. But the girls here don’t find that a problem.” Another guest explained how the activities they wanted to do during their stay were discussed prior to their stay and records confirmed this process.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 13 One service user was observed independently moving around the house in a wheelchair and accessing their room by using the lift. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users receive personal support appropriate to their needs and preferences, which enables their privacy and dignity to be respected. EVIDENCE: Service users confirmed that they direct their terms of personal care. They also confirmed that their dignity and privacy is always respected and care is taken to ensure that their personal image is also respected and assistance is given to dress with the person’s choice of clothing and style. The observation of the interaction of staff and service users confirmed this. The manager stated that so service users’ independence is promoted and the care is consistent with that received at home personal aids such as electric mattresses, electronic communication aids and electric wheelchairs are brought to the service with them. However hoists, bathing equipment, raised toilet seats and cushions etc. are also supplied by the service. Some people using the service need to receive their food and medication administered through a PEG (Percutaneous Endoscopic Gastrostomy). Records prove that there are written guidelines given by a healthcare professional for staff to follow in relation to this procedure. However staff were last trained by a specialist nurse to carry out the procedure safely and correctly prior to August 2004, this training now needs to be updated.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 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 the following standard(s): 22,23 Arrangements are in place to help protect guests from abuse and to seriously address complaints and concerns about the service. Although a recent Adult Protection issue has been satisfactorily addressed the service initially failed to appropriately follow the procedures set by the Local Authority. EVIDENCE: The home follows the Adult Protection Procedures set by the Local Authority. However recently the correct procedures in relation to alerting the appropriate agencies after an allegation of abuse being reported were delayed. This was addressed with the manager during the investigation where the outcome found the allegation not to be upheld. Although prior to the allegation being made some of the staff had received training in relation to the Local Authority’s Adult Protection Procedures not all staff had, partly due to the local authority not being able to meet the demand of training requests from this and other homes. Three dates for the Responsible Person training are now arranged and the home is currently waiting for confirmation from the Local Authority’s POVA Coordinator for training dates for the staff who have not yet received training. In addition to this the manager and staff confirmed that in house training has taken place in relation to protection issues and the manager has also addressed issues in relation to good respectful care practice by raising staffs’ awareness of what is acceptable and what is unacceptable care practice. All of the guests spoken to at this and previous inspections confirmed that they are treat with respect at all times.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 16 Guests confirmed that they knew how to complain and they felt that their concerns were listened to and addressed appropriately. A copy of the complaints procedure is available in the home. The manager explained that discussions take place with each guest prior to them leaving to make sure that everything during their stay has been to their satisfaction and whether anything could have been better. The results of such conversations are recorded in individual care files and the issues raised, if any, are addressed prior to the next visit. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 17 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): 24,27 As a result of effective maintenance and refurbishing programmes, and good cleaning schedules the standard of the environment is good, providing service users with an attractive and homely place to stay. EVIDENCE: The environment, which was clean and tidy, maintains the same high standards as found at previous inspections. All areas of the building are nicely decorated and furnished to a good standard. Four electric recliner chairs are available in the lounge, all offering different aids to address different mobility needs. The bathroom facilities where a specialised bath and separate shower facility address the varied needs of the guests remain satisfactory. An accessible toilet that is located on the ground floor and in close proximity to the communal lounge and dining area has recently been decorated resulting in a brighter environment. The manager stated at a previous inspection that there are plans to refurbish the room with new facilities in the near future. The previous recommendation to replace the window with obscure glass at the same time remains.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 18 The home has carried out risk assessments for each person who uses the service in relation to having unguarded radiators and in the event of a risk being identified the radiator(s) in question are covered with soft protection. This was evident during the inspection. However it remains a recommendation of this report that radiator covers should be fitted to all radiators. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 19 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): 32,35,36, Regular training opportunities ensure that guests are appropriately supported and protected by a competent and qualified staff team. However although service users’ care needs and staffs’ care practices are monitored effectively by the manager carrying out direct supervision “on the floor”, there are no formal recorded supervision sessions, therefore the manager has no written record of the issues discussed and addressed with staff. EVIDENCE: Staff discussed the needs of the guests with respect and understanding. When observing staffs’ social interaction with guests, their response, and the way they addressed guests’ needs, it was evident that positive relationships continue to develop. Some training providers, who have ceased to provide training, have affected some staff training opportunities. There were no staff supervision records to examine, however the manager stated and staff confirmed, that staff are directly supervised while they work. This includes the manager working as a role model alongside other staff and generally discussing good care practices and the values needed when working with vulnerable people. The manager also stated that she finds it difficult to organise enough time to carry out formal supervision sessions that are planned and recorded, however staff confirmed that if they need private time with the manager this is accommodated.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 20 The manager was again advised of the advantages of planned and recorded supervision sessions. Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The manager, who is well supported by the staff team, provides a service that is well run, safe, and focussed on the best interests of the service users. EVIDENCE: This home is well run by a manager that is competent and consistent in her role. Although the manager has a teaching qualification, managed the home for thirteen years and has a wealth of experience shared with her business partner who for many years prior to retirement was a qualified nurse, she has not a qualification in care or management. The manager states that if necessary she intends to seek advice from one of the home’s senior members of staff who is currently doing the Registered Managers Award and NVQ 4 in Care. The managers need to gain an appropriate qualification remains a Requirement of this report. The fire records and accident book were satisfactory. The only health and safety issue is related to the radiators without covers.
Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 22 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X X X 2 X X X X 2 X Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 23 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 YA18 Regulation 18(1)(c )(i) Requirement The training received by staff in relation to the procedures carried out when supporting service users to feed via PEG (Percutaneous Endoscopic Gastrostomy) feeding must be monitored and reviewed. To ensure that service users are protected and any allegations of abuse are taken seriously and promptly any reported allegations must follow the guidelines of the Local Authority’s Protection of Vulnerable Adults (POVA) Procedures and any allegation must be promptly reported to the appropriate agencies. All staff that have not already done so must receive training in these procedures. All staff must attend training in relation to their role and in particular including First Aid, and be given time off to attend where necessary. So that a qualified workforce supports and protects service users the manager must ensure that the home works towards
DS0000015747.V273768.R01.S.doc Timescale for action 31/03/06 2 YA23 13(6) 30/04/06 3 YA32 18(1)(c ) 31/03/06 4 YA35 & YA32 19(5)(b) 30/11/06 Donna Claire Venture Short Break Service Version 5.1 Page 24 achieving and maintaining 50 of the workforce qualified in NVQ. 5 YA37 9(2)(i) So that the manager gains the 30/04/06 recognised qualification she must register for the Registered Managers Award and NVQ 4 in Care or another relevant qualification. 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 A24 & YA42Y YA27 Good Practice Recommendations The manager should ensure the safety of the service users by ensuring a low surface temperature on radiators, for example through the use of radiator guards. The plans to refurbish the toilet on the ground floor with facilities appropriate to the needs of people with disabilities should go ahead, while at the same time it is recommended that consideration is given to replacing the windows with obscured glass. Each member of staff should receive at least 6 planned supervision sessions per year and an annual appraisal that are recorded in written form. 3 YA36 Donna Claire Venture Short Break Service DS0000015747.V273768.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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