CARE HOME ADULTS 18-65
Douglas Close 19 Douglas Close Jacobswell Guildford Surrey GU4 7RB Lead Inspector
Christine Bowman Unannounced 26 April 2005, 13.30 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. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 19 Douglas Close Address 19 Douglas Close Jacobswell Guildford Surrey GU4 7RB 01483 537181 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) Mrs Pamela Mary Eales Miss Adrianne Gallagher Care Home 3 Category(ies) of LD Learning Disabilities - 3 registration, with number LD(E) Learning Disabilities over 65 - 2 of places H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The Age range of the persons to be accommodated will be 45-65 years of age, up to 2 (two) being over 65 years of age 2 Up to 2 service users may be category LD(E), Older people with learning disability Date of last inspection 6 October 2004 Brief Description of the Service: 19 Douglas Close is an attractive detached bungalow in a quiet close in Jacobs Well village. Although very close to Guildford with its large range of public services and amenities, this village has a thriving community spirit and the residents of 19 Douglas Close are very much at the heart of it, This home has three large bedrooms for the residents and attractive communal spaces, including a large sitting/ dining room, a kitchen and utility room, bathroom, separate shower room, and an activity/visitors room in the garden. There is a terraced area in the garden for eating out in the summer, and parking spaces in the drive and on the road . The placements at this home are for three people with learning disabilities who are over the age of forty five years. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, four hours in duration, during which all of the three residents were very willing to share their experience of life at 19 Douglas Close. The manager, the deputy manager and one other member of staff were also very helpful, care plans and other records were viewed, as was the accommodation. The immediate impact of this home was that it provided a very happy and fulfilling lifestyle for the residents who live there. “I’m going riding tomorrow” said one resident as we were introduced. “I haven’t been before, it’s my first time”. “I like my music and dance teacher, she’s very nice”, said another. What the service does well:
This home positively empowers people to develop their own individuality, giving support to enable the people who live in the home to do the things which make them feel happy and fulfilled. “Would you like to see my scrapbook ?” asked one resident. He brought two scrap-books, with pictures of the Royal Family covering a century, cut out, arranged and glued in. He particularly liked the ‘Queen Mother’, and had collected pictures of her from when she was a child. He then brought photographs of trips to London, the home had arranged for him to see the ‘Changing of the Guards’. Before the photographs had been seen, a video was set up and all the staff and residents had been transported back to the time of the ‘second world war’. They were putting on a song and dance show in the village hall for friends, neighbours and residents from other ‘Just Homes’ homes. Everyone was dressed in clothes of the thirties and forties, there were soldiers and nurses etc. and the excited resident was pointing to himself dressed as a soldier and dancing with his singing and dance teacher. “She’s nice, she is!” he was saying, with a huge smile on his face. 19 Douglas Close is at the centre of the community of Jacobswell, organizing social events for neighbours and friends to attend. Interaction between the residents of the ‘Just Homes Homes,’ is also encouraged, ensuring residents have fulfilling social lives. “I went on holiday with my friend,” said a resident showing, photographs of herself and her friend on the beach.
H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. H58 S13457 Douglas Close v223070 260405 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 H58 S13457 Douglas Close v223070 260405 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) 1,2 ,3 and4 Information is available for residents to decide if this home will meet their needs. Resident’s needs are assessed and prospective residents know their needs and aspirations will be met at Douglas Close. EVIDENCE: Both the statement of purpose and the service users guide contained all the required information and the service users guide is user friendly, containing colourful symbols to assist with understanding. The most recent admission was in 1999 and records showed that there had been three pre-admission visits and a full assessment by the community social work team, this included a day centre assessment, transitional planning, discharge meeting, personal information, behaviour needs, health needs, personal and social needs. A member of staff stated that a visit had also been made to the resident at the hospital where he had been placed, prior to admission to 19 Douglas Close. This resident, was quoted by the manager and the deputy, as thanking them frequently for moving him to the home and adding, “You won’t let me be taken from here, will you? H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 Residents are enabled to make decisions about their lives and are encouraged to contribute to decisions about any changes to the running of the home. EVIDENCE: Resident’s care plans are reviewed three months after admission and subsequently at six monthly intervals. A new pictorial quality assurance questionnaire for residents to complete prior to review meetings has been developed. Feedback from residents and care managers confirmed that this was an excellent tool in ensuring that resident’s views and opinions were made more available at review meetings. Care plans viewed were very detailed and a recent review of one resident whose health is deteriorating, in that his mobility is reduced and his dependence increased, revealed that resources had been purchased and adaptations had been made to the interior and exterior of the building to accommodate these needs. Grab rails have been installed throughout the home, a full- length corridor rail, wall protection cover has been fitted, a hoist, a bed raiser and a commode installed and ramps have been fitted to exit
H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 10 doors. Risk assessments were in place to ensure the safety of resident involved in new activities. H58 S13457 Douglas Close v223070 260405 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) 11,12,13,14,15,16 and 17 Residents have many and varied opportunities for personal and social development, have their rights and responsibilities respected in daily life and are encouraged to follow individual hobbies and interests. EVIDENCE: The initial meeting with the residents of Douglas Close revealed very definite individual characters, who were confident and happy in their home. Each had his/her own special interests, which they were encouraged to pursue by their attentive and supportive staff. One resident has a special interest in collecting dolls, which she displays in her room. She has a friend who shares her interest, and she was keen to show photographs of their seaside holiday together. Her friend is a resident of one of the other ‘Just Homes’ homes and they regularly invite each other over to socialize. The residents are members of social clubs, attend local churches and use leisure facilities both in Guildford and Woking, including libraries, cinema, theatre, restaurants and shops. They attend local college courses and day centres and enjoy holidays and day trips to a variety of destinations (seaside,
H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 12 farm visits, garden centres, the zoo etc.) One resident excitedly produced a photograph of herself, a friend and a member of staff enjoying a trip in a hot air balloon. Another resident who has been on holidays in the past, has decided that he would prefer to take day trips because he gets home sick when he stays away. One of the residents stated that he likes to go to church and, if for any reason he can’t, the priest comes to visit him. This resident is very involved in the local community, being a member of the Jacobs Well Village Association, he attends meetings and is treated as a VIP at events such as Fetes. All the residents have responsibilities around the home which they have chosen, and one resident whose job is to set the table, likes to know that the staff would not be able to manage without his input, “What would you do if I wasn’t here to set the table,” he frequently asks the staff. Another resident likes to keep the home tidy, and enjoys doing her own washing. Menus are arranged with the residents on a weekly basis and they also shop and assist with the cooking. As the time was approaching for the evening meal at Douglas Close, a member of staff and a resident were working together in the kitchen to produce ‘chicken chasseur’. H58 S13457 Douglas Close v223070 260405 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, 20and 21 Personal and healthcare needs are met, specialist help sought when required, and staff receive the training to ensure that tasks are carried out safely. EVIDENCE: One of the residents has been suffering from deteriorating health problems for some time now and it was commendable that the staff of Douglas Close, have been sensitive and flexible in their approach. Care plans indicate thorough risk assessments with regard to mobility issues, and the involvement of specialists throughout the process for advice and training. Key workers are allocated to residents and every effort is made to ensure that all the residents have contact with family members where this is possible, otherwise advocacy services are made available to them. The garden room provides an ideal private space for such visits. One resident has family members who live abroad and the resident is supported to keep contact by letter. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 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 standard(s) 22 and 23 The practise of listening to the residents is backed up by procedures to ensure that the residents are protected from any kind of harm. EVIDENCE: Policies and procedures, which are frequently updated and signed by the staff when they have been read, are in place to protect the residents. The complaints policy is very clear and a condensed version is contained in the statement of purpose and the service user guide in the same format. Although there are many safeguards in place, including the use of advocacy services for those who have no relatives, the complaints procedure could be in a form, which is more assessable to the residents. There had been no complaints since the last inspection, the manager stated, and a suitably bound book will be in place when it is required. The Surrey County Council ‘Multi Agency Vulnerable Adults Procedures’ were in place and training is scheduled to be updated this year. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28 and 30 The home environment meets the needs of the residents. EVIDENCE: All the residents have large rooms, which reflect their taste and interests. One room was decorated in colours of her choice and contained a collection of dolls and many compact discs of music. Also sleeping in the room was the resident’s own pet cat. Another room displayed a huge poster of a football player, which the manager stated, was a relative of the resident, whose claim to fame had been that he was player of the year for a prominent team, in the same year that a very famous player had been the runner up. Football is this resident’s passion. The walls of the third room were covered in posters of the Royal Family and covering the bed was the Irish flag. This room had French windows leading to the garden. All the bedrooms were appropriately furnished and had lockable units.
H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 16 Communal rooms were homely, comfortable and tastefully decorated. Framed photographs of residents and resident’s relatives were displayed in the living room. The furnishings were domestic, and of good quality. The home was well maintained, in good decorative order, and a programme of redecoration is included in the home’s development programme. In addition to a well-equipped kitchen and separate utility room, there is a garden room where guests can be entertained in privacy, two offices and a terraced area in the garden for summer use. The bathroom is fitted with mobility aids, and there is a separate shower room and toilet. The garden and drive area is well maintained and there is wheelchair access to external entrances. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 The residents of Douglas Close receive care of the highest quality from a staff team who are suitably qualified, trained, supported and enthusiastic. EVIDENCE: From viewing the practise of staff members at Douglas Close, it was evident that the philosophy of the home was understood and actively followed. Interaction between staff and residents was respectful, residents were empowered, given choices and enabled to live fulfilling lives. As the evening meal was being prepared in the kitchen, the resident and the member of staff were happily engaged in conversation, they were laughing and clearly enjoying each other’s company. Intermittently the resident asked for instructions, which were given clearly. At all times the resident was making the decisions and the member of staff was in an enabling role. One resident had been involved in the recruitment process of staff, the manager stated, and all potential candidates for care posts must meet with the residents before a decision can be made. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 18 Staff files contained all the necessary documentation as detailed under schedule two of the Care Homes Regulations 2001. The well-established staff team meets the needs of the residents. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 19 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) 37,38,39,40,41,42 and 43 The management style of Douglas Close empowers residents to be fully involved in the running of their home. EVIDENCE: The management approach of this home creates an open, positive and inclusive atmosphere. Residents are able to contribute in residents’ meetings and through quality assurance questionnaires to the development of the service. One resident takes full responsibility for the cleaning rota and ensures that, her high standards are, adhered to by all. Commitment to the training and development of staff is evidenced in staff files, core training is regularly updated and the staff, have either achieved a relevant qualification or they are enrolled and working towards one. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 20 This is a safe home where records show that safety checks are completed regularly. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 21 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 3 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 4 4 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 4 x 3 Standard No 11 12 13 14 15 16 17 3 4 4 x 3 4 3 Standard No 31 32 33 34 35 36 Score 3 3 4 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 22 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 Regulation Requirement Timescale for action 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 YP22 YP22 Good Practice Recommendations It is recommended that the complaints policy is made available to residents in a format which is more accessible to them. It is recommended that a bound book be made available for the recording of residents complaints. H58 S13457 Douglas Close v223070 260405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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