Inspection on 26/07/05 for Downside

This inspection was carried out on 26th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Downside 08/11/07

Downside 01/08/06

Downside 13/02/06

Downside 10/03/05

Downside 05/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Downside The Avenue Kingston Lewes, East Sussex BN7 3LW Lead Inspector Paul Endersby Unannounced 26 July 2005 10:00 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 Older People. 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. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Downside Address The Avenue Kingston Lewes East Sussex BN7 3LW 01273 471604 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 Maria Bermingham Mrs Maria Bermingham Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (OP), 3 of places Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number must not exceed 3 2. The people accommodated will be elderly people over the age of 65 years Date of last inspection 10 March 2005 Brief Description of the Service: Downside provides accommodation for 3 older people. The home is situated in the village of Kingston, near to the town of Lewes. The building comprises a large detached bungalow with extensive gardens, to which the service users have full access. The Manager and her family live on site. The home adheres to the standards of the British Soil Association and an organic diet is provided for residents. There are three cats, three dogs, three ponies and numerous chickens so anyone choosing to live at Downside needs to like animals. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the morning. The Inspector met with the service provider/manager and two of the three residents. In addition he had looked over the parts of the building used by residents, and part of the garden. Various records and other documents were reviewed as part of the inspection. It was evident that the provider, who is responsible for the majority of the direct care, is very committed to the residents and provides a very personal service. The inspection lasted 3¼ hours. What the service does well: 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. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 & 5 The pre-admission assessment process is limited and potential needs could be overlooked. However pre-admission visits assist both the manager and the resident in coming to an informed decision about where to live. EVIDENCE: Each service user has been given a detailed contract or terms and conditions of residence. The document needs to be updated to reflect the change of regulatory authority both in regard to registration and the complaints procedure. There have been no admissions to the home since the last inspection. However there was evidence that the policy is to visit prospective service users in their own surroundings to meet with them and to carry out an assessment of abilities and needs. Following this the person is invited to the home to meet with the other residents and to view the accommodation available. Notwithstanding this the assessment process followed is not entirely compliant with the National Minimum Standards (NMS). The manager operates a trial period of 4 weeks. During this time, the initial assessment is reviewed and decisions are made as to whether the residents’ needs can be fully met. Emergency admissions are not accepted. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 , 9 & 10 The arrangements for monitoring resident’s health care requirements contribute to ensuring that their needs are met. Their privacy and dignity are respected. EVIDENCE: Residents have access to community health services including district nurses and continence advisers. Specialist services and advice is also available if required. During the inspection the Inspector was able to meet with one of the Community Nurses attending the home. All medical visits are recorded on file and specialist equipment is provided where necessary. The home takes a particular interest in the management of digestive complaints by providing residents with a balanced organic diet. One resident is bed bound and has been so for several years. A community nurse attends her twice a week. The Inspector discussed with the service provider/manager the extent to which she is personally providing nursing care. The Manager normally administers all medication in the home. Other members of staff have received training from the manager to perform the task in her absence, should this be necessary. All drug charts are signed and recorded appropriately. There is a locked cupboard for medication. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 9 One resident has been assessed as able to self medicate in respect of part of her medication. The manager undertakes spot checks to monitor the situation. Resident’s preferred term of address is documented in their care plan. There are individual telephone lines in all of the bedrooms, although only one of the current residents has taken advantage of this facility. The residents spoken with talked positively about the care they receive and confirmed that staff at the home are kind and helpful and show respect for their privacy and dignity. The layout of the home and generous room sizes offer residents the opportunity to spend time alone or in the company of others. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 Residents are encouraged and enabled to maintain contact with their families and with the local community. EVIDENCE: Visitors are welcomed in the home. Residents are supported in maintaining links with the local community, attending church and visiting the local town. A taxi comes to the home every week to take residents to places of interest in the locality. In addition residents are offered outings to the village when a community event is being arranged and at other times if they wish. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Appropriate arrangements are made to ensure residents are protected from abuse. EVIDENCE: A policy on adult protection and the prevention of abuse has been prepared. This identifies Social Services as the lead agency on adult protection matters. Since the last inspection the policy has been amended to identify when other agencies should also be contacted, e.g. the Police and CSCI. Policies have also been prepared in regard to whistle blowing and managing aggressive behaviour. The manager has undertaken appropriate training in regard to adult protection and adult abuse. Checks on all staff that work in the home with the Criminal Records Bureau (CRB) have been undertaken, although apart from the manager, these have been done by the staff members other employers. Residents who spoke with the Inspector said they felt safe in the home and are treated well. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 & 26 Residents live in a safe, comfortable and non-institutional environment which is well maintianed. EVIDENCE: The home is well maintained and furniture and fittings provided are comfortable and homely in design. The layout of the home provides accommodation that is suitable for its stated purpose. All bedrooms and communal areas are comfortable and domestic in appearance. The garden contains a variety of animals and extensive views of the Downs and surrounding countryside that are particularly enjoyed by the residents. There are regular inspections by the Environmental Health Department and an external contractor has undertaken a risk assessment of the home in respect of fire safety. Fire drills are carried out regularly and records are maintained. All radiators presenting a risk to residents have been fitted with guards. The home is warm and adequately ventilated. The water temperature is regulated with pre-set temperature mixing valves. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 13 Laundry facilities are appropriately sited and the home is clean. However as recorded in the last inspection report, there was again an odour from the dogs. It is accepted that the dogs have restricted access to certain parts of the house. There is a policy in place on the control of infection. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 & 30 Information on recruitment procedures and practices needs to be made readily available. The staff training programme is primarily confined to the manager, with other staff receiving training elsewhere. EVIDENCE: Apart from the resident service provider/manager all other staff are used in the home on an occasional basis only. The service provider/manager stated that she takes no more than three weeks holiday a year and therefore provides the vast majority of administrative and caring tasks herself. Currently there are seven other people who provide relief staffing as and when required. However staff personnel files were not available for inspection on this occasion. It was therefore not possible to confirm that the recruitment of staff complies with the NMS. As already stated the Inspector was advised that all staff members are also employed elsewhere and CRB checks were obtained via their employers. The manager has seen sight of the checks. The cleaners work for an agency. The Inspector was informed that the manager has checked to ensure that the agency has followed thorough recruitment procedures. Staff receive an induction based on the policies and procedures of the service. All staff receive training in food hygiene. District nurses have provided training in moving and handling on site. Since the last inspection the manager has acquired a copy of the TOPSS standards to ensure that the induction process is modified to ensure compliance with those standards. However there have been no new staff since the last inspection. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 & 38 The manager is competent and experienced and the home is run and in the best interests of the residents. Appropriate policies and procedures have been provided and records are maintained. The arrangements for ensuring resident safety are sufficient for the residents at this time. EVIDENCE: The manager is a qualified general and psychiatric nurse. She has owned and managed the home since 1986. She keeps up to date with changes in care practices through magazines and attendance at relevant training courses. There are a wide range of policies and procedures in place, most of which are very brief in their content. Supervision sessions as such largely take the form of informal updates that are then recorded in the communication book which impinges on personal confidentially. All records that were seen during the inspection were well maintained and up to date. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 16 Action is taken to provide a safe environment for residents. There are written policies in regard to fire safety, first aid, food hygiene and infection control. Training is provided in some but not all of these areas. There are annual checks of electrical systems and equipment, although the relevant certification was not available to confirm this. The oil-fired boilers are serviced twice a year. Accidents are recorded. Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x 3 2 STAFFING Standard No Score 27 x 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x x x x 2 3 3 Downside H59-H10 S21353 Downside V236295 260705 Stage 4.doc Version 1.40 Page 18 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. 3. 4. Refer to Standard 2 3 26 29 Good Practice Recommendations The statement of Terms and Conditions should be revised to ensure all the information is up to date. All residents who have not received a Social Care assessment should be assessed within the home in compliance with the National Minimum Standards (NMS) Action should be taken to remove the odour from the dogs. Staff personnel files should be made available for inspection. 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