Inspection on 08/11/07 for Downside

This inspection was carried out on 8th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 01/08/06

Downside 13/02/06

Downside 26/07/05

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 Church Lane Kingston Nr Lewes East Sussex BN7 3LW Lead Inspector Jason Denny Key Unannounced Inspection 11:30 8th November 2007 X10015.doc Version 1.40 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 Downside DS0000021353.V348717.R01.S.doc Version 5.2 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 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 DS0000021353.V348717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Downside Address Church Lane Kingston Nr Lewes East Sussex BN7 3LW 01273 471604 01273 471604 maria.bermingham@googlemail.com 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) Mrs Maria Bermingham Mrs Maria Bermingham Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents to be accommodated is three (3). Residents must be older people aged sixty-five (65) years or over on admission. 1st August 2006 Date of last inspection Brief Description of the Service: Downside provides accommodation for 3 older people. The home is situated in the village of Kingston, near Lewes in East Sussex. Downside is a large detached bungalow with extensive gardens, to which the residents have access. The owner/manager and her family live on site and provide care to residents. The manager keeps chickens and grows the vegetables eaten in the home. The home adheres to the standards of The British Soil Association and the food provided in the home is totally organic. The manager also keeps dogs and Cats and ponies. Anyone who wishes to live at Downside will need to like animals. One residents’ bedroom has full en-suite facilities with the other two having a hand washbasin. There is level access to the extensive gardens and the manager has a vehicle for transporting residents into the wider community. A copy of the homes’ Statement of Purpose and Residents Guide is provided to anyone making an enquiry about the home. Copies of inspections reports are made available on request. Fees charged range from £370 to £415 which is same for both self funders [private] and those fully funded by Social Services . The higher rate relates to the bedroom with the en-suite bathroom. Newspapers, trips outs, toiletries, hairdressing and vitamin supplements are included in the fee. Additional charges are made for chiropody. Intermediate care is not provided. The email address is maria.bermingham@googlemail.com. The reader should note that due to the size of this home a number of standards relating to staff and staff training are not wholly applicable as the Manager provides most of the care to residents. The home is also exempt from some fire regulations as resident numbers never go above three persons. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 11.30am and 2.40pm on November 8th, 2007. The inspection focused on checking that the good outcomes evidenced in the last inspection report of August 1st, 2006 have continued. This visit also included reviewing progress with the minor improvements required in the last report. Care records along with health and medication needs of all three current Residents were looked at. Discussions with management looked at lifestyle opportunities with a focus on the newest resident. The inspector toured all communal areas of the home with meal arrangements examined. A record of complaints was inspected. Staffing was looked at in detail along with how quality is maintained and improved upon. The inspector met with all current residents and examined written feedback stored in the home from each resident’s relatives, friends, and visits by a range of professionals such as those from social services. In addition the inspector also phoned some other professionals involved with the home immediately following the inspection. The visit also included observation of care-practices The home sent back to the Commission a completed annual quality assurance assessment before the visit which informed inspection planning and this report. Five-outcome areas are judged to be Excellent and the other two are assessed as Good, with no improvements required. What the service does well: Residents and all those connected with the home indicate that Downside is excellent and in many respects a uniquely specialised service due to it small size and nature, which provides the best possible outcomes for residents. Typical quotes from relatives, friends and Social Services connected with all three residents are fulsome in their praise : “It is home from home”. “It is better than my own home due to the special support I receive” . “ High quality care delivered with a special emphasis on recognition of each individual as a valued member of the household”. “The Quality of life is given high priority” “ Excellent carry over and continuation of her treatment resulting in improved mobility and daily activities”. “She [named] has only been in the home four days and already looks brighter, enjoying a wonderful environment”. “The Manager is a conscientious and Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 6 efficient carer”. “ We could not have found a better home”. “I would always recommend the home, confident about using it fulfils a need and overall is brilliant. It is shame there are not more such small services out there for older people” The home continues to provide a high quality service to all residents. The atmosphere of the home is comfortable and relaxed and residents are encouraged to treat Downside as their own home and follow their own interests. This is made easier by being a service for older people, which never goes above 3 residents within a family style home. Key to the excellent outcomes in the home is the commitment and high level of experience of the manager who is a retired nurse and who ensures that resident’s health needs are given full attention. The size of the service also allows for an exceptional focus on resident wider social and occupational needs. Meals are varied, nutritious and wholesome. Concerns from residents are given exceptional care. There are effective systems in place to ensure residents health, welfare and safety are promoted and protected. 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. The summary of this inspection report can be made available in other formats on request. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, 4, 5, & 6. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from excellent pre-admission assessments that are carried out prior to residents moving into the home, which ensure that their needs can be met. Prospective residents are provided with good information on services provided by the home to enable them to make an informed choice. Resident’s receive excellent value for money protected by clear contractual terms and conditions. EVIDENCE: The home has a Statement of Purpose and Residents Guide that is regularly updated, as shown in the copy inspected, to accurately reflect services Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 9 provided by the home. Most recent inspection reports showed evidence of being signed by residents and visitors to confirm readership. Each resident has a contract that outlines their terms and conditions of residence and ensure they are clear about services offered by the home. Fees charged range from £370 to £415, which is same for both self funders [private] and those fully funded by Social Services. The higher rate relates to the bedroom with the en-suite bathroom. Newspapers, trips outs, toiletries, hairdressing and vitamin supplements are included in the fees. Additional charges are made for chiropody. The inspector sampled one contract of the newest resident which showed the fee of £415 and was signed and agreed once the resident decided to move permanently into the home after 1 month trial period. The manager also confirmed that social trips and meals out are included in the basic fee to ensure that residents do not decline trips out if they have to pay themselves. Prior to the trial period the newest resident had visited several times for meals and spent a whole day in the home. The pre-admission assessment for the last resident to be admitted was viewed and found to be satisfactory. The manager maintains a daily care diary during the one month trial period in order to provide a continuous assessment as to resident’s care needs and this information is used inform the care planning process. A detailed pre- assessment was carried out on the newest resident on May 27th before moving in on June 1st 2007. Social Services praised the way in which the home manager carefully assesses residents before confirming whether a prospective resident can move in. A recent example was quoted of a referral being made with the manager deciding that the home would not be suitable. Intermediate care is not provided so standard 6 is not applicable. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from excellent Care planning with full involvement from residents, which ensures that all aspects of personal, social and health care needs are effectively identified and planned for. EVIDENCE: Care plans for the three residents were viewed and found to contain a full range of useful information to the benefit of each individual resident. Detailed evidence was seen of how carefully the health needs of each resident are monitored with clear evidence of improvement and range of medication changes initiated by the manager working closely with a full range of professionals. Decision-making was shown to involve all relevant persons. Routines are based on the diverse needs and preferences of each individual. The manager maintains detailed medication administration charts which includes a list of all medications prescribed for residents. Care plans showed Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 11 regular evidence of detailed and close working with the GP and Community Nurse to ensure that the home is able to fully meet resident’s healthcare needs. The manager’s own experience and expertise as a nurse enables residents to have good health care and appropriate medication. Written evidence showed how the manager ensured that medication was reviewed in a resident’s best interest by ensuring that the home obtained a detailed medical history and full information on the side effects of a potential new medication. Care-plans clearly show each resident’s strengths and weaknesses and what capacity they have to maintain independence in relation to personal care with detailed guidance as to what support is required. Discussion with the two residents who could express a clear view praised the high quality of the care they receive and pointed to improvements in health since moving into the home. They confirmed they are shown consideration and their privacy and personal preferences are respected. They confirmed that they feel their personal preferences are respected at all times. A copy of care notes are provided for each resident, which is held in their rooms. Relatives are kept informed of changes in care needs and invited to look at the latest inspection report. One survey completed by a relative on behalf of the resident said ‘I have found the care to be truly excellent’. This was confirmed by the positive comments made by all other relatives, and visitors to the home including health professionals as evidenced in the homes comments book. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, & 15. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents are actively supported to exercise choice over their daily lives and pursue as many interests and social opportunities as are reasonable. Residents are central to the running of the home and are supported to have excellent links with the community. Residents benefit from excellent meals offering both choice and variety. EVIDENCE: Routines of the home are flexible and residents are encouraged to continue with past and present activities. The manager maintains a photograph album of various birthday and Christmas celebrations that have taken place in the home, including afternoon tea taken in the garden during the summer. Regular outings [at least twice weekly] are arranged and participation in village activities is facilitated. A newer resident since recovering from health issues has received a marked increase in activities with four new visitors coming in the home to provide stimulation. The environment of the home such as the Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 13 conservatory and large garden is used by residents. All resident were found to have a number of facilities for mental stimulation with the home also used for social meetings and church services. Menus are changed regularly with residents encouraged to suggest changes based on their individual preferences. Wherever possible all food is organic with the manager providing any approved vitamin supplements when required. The weekly menus are varied and the manager ensures they include fish and vegetarian dishes in addition to meat to ensure residents nutritional needs are fully met. The home was found to have a range of fresh food with meals highly praised by visitors such as relatives and Social Services. It is evident from written records and discussions that residents are fully involved in the running of the home with high consideration given to their views. The manager actively encourages residents to keep in touch with family and friends and visitors are welcome at all times. The visitor’s book showed high number of diverse visitors for each resident with lot of effort placed on supporting residents to have community links without always needing to go out. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, & 18. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents and visitors feel able to express any concerns, confident that they will be listened to and acted upon with effective systems in place to protect residents from abuse. All those involved with the home continue to describe it as excellent with no complaints or concerns for many years. EVIDENCE: The complaints book was viewed and no complaints had been received since the last inspection. The last complaint/concern was over 3 years ago and involved the manager proactively working with the resident to improve air quality with exceptionally detailed records showing how each improvement measure was agreed with, and found to benefit the resident. The home has written policies and procedures on both complaints and adult protection. Two residents spoken with stated that they could talk to the manager should they have any concerns. The manager has had training [2006] in updated adult protection procedures provided by the local authority. No complaints or allegations have been received by the CSCI. All relatives and Social Services professionals were fulsome in the praise of the home typically describing it as “excellent.” Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, & 26. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The standard of decor within the home is good, with residents benefiting from a very homely, safe, clean and comfortable environment. EVIDENCE: The inspector toured all areas of the home used by residents. Since the last inspection all electrical wiring has been upgraded to make the home safer. Residents bedrooms are spacious, well maintained and attractively furnished. Throughout the home decor is good and Residents are encouraged to personalise their rooms with pictures and ornaments. All parts of the home were clean, tidy and free from offensive odours or hazards. The manager confirmed that the fire service has informed that fire doors are not necessary in a home for less than four residents. The home is exempt from fire service inspections. Fire fighting equipment continues to be regularly serviced. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 16 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a small, sufficiently trained and appropriately recruited care team. EVIDENCE: The manager provides most of the care to Residents but has two part time carers to provide care in her absence along with a domestic worker who prepares meals on occasions and is not involved on the care-side. One of these carers is a trained nurse in her own country although they have undertaken a full induction and training in the home, including moving and handling and infection control procedures. When a carer is deputising for the Manager she is provided with detailed instructions as to the care needs of Residents including their likes and dislikes in respect of food and daily routines. The other carer is also experienced. All staff working in the home were found to have full checks carried out before working in the home as seen in records examined. Staffing levels are flexible depending on outings with two of the staff [which includes the manager] living in the home. All three residents were found to receive attentive care. All residents have low to medium needs. The manager was observed during the inspection as the carer on duty and ensured all residents received the care they needed. All residents can weight bear with one staff person in attendance. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 17 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, & 38. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from a exceptionally well managed home that is run in their best interests based on the skills, knowledge, and commitment of the manager. EVIDENCE: The manager has been managing the home since it opened 20 years ago and she has extensive experience in caring for older people and is a trained nurse undertaking all relevant training such as adult protection. The manager continues to keep themselves up to date with developments in the field of the care of older people. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 18 As part of quality monitoring the manager makes copies of inspection reports available to relatives and residents and invites them to write comments on the front page. Consultation with residents is on a daily basis due to the small size and informal and friendly ethos of the home. A comments book is maintained and completed by visitors such as relatives and professionals. This showed highly positive comments throughout since the book’s inception in 2003 and covered all three current residents. Typical comments described the home as “high quality”. It is evident that the manager is maintaining a quality service to the benefit of residents. The manager is currently exploring ways of increasing regular outings further. Given the excellent outcomes and small nature of the service an annual development plans and formal annual written surveys of stakeholder views are not required. Residents are responsible for their own finances. Where appropriate; relatives and solicitors support others, with the home not handling any financial affairs of residents. Given that the home fees cover a range of items usually charged as extras such as toiletries, newspapers and outings, the need for residents to use their own money is much reduced. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. All staff working in the home have received appropriate moving and handling training as confirmed by the manager. Records showed the regular testing of fire alarms and monthly fire drills involving residents .The certificate of liability insurance was made available and demonstrates residents and staff are fully protected. Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 19 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 4 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No 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. 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. Refer to Standard Good Practice Recommendations Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Downside DS0000021353.V348717.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!