Inspection on 25/10/06 for Durrants Care Services Ltd

This inspection was carried out on 25th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Durrants Care Services Ltd 24/10/08

Durrants Care Services Ltd 10/03/06

Durrants Care Services Ltd 16/09/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Durrants Care Services Ltd Durrants Court Barn Ashford Road High Halden Kent TN26 3BS Lead Inspector Mrs Sally Gill Unannounced Inspection 25 October 2006 08:35 th Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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 Durrants Care Services Ltd DS0000064523.V301414.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 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. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Durrants Care Services Ltd Address Durrants Court Barn Ashford Road High Halden Kent TN26 3BS 01233 850014 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) Mr Joseph Graham Mr Joseph Graham Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration numbers to revert to three (3) when couple move out. Date of last inspection 10th March 2006 Brief Description of the Service: Durrants Care Services is registered to provide accommodation for 3 adults with learning disability. It accommodates service users with low to medium dependency needs. The Registered Manager, Mr Joe Graham has day-to-day responsibility for the Home. The premise is a converted barn with accommodation on the ground floor. The annex has self-contained accommodation comprising of a bedroom with ensuite bathroom and a lounge/diner with kitchenette. In the main house there is two additional bedrooms, one with a full ensuite shower room and the other has access to a bathroom. In addition residents share a very spacious lounge and kitchen/diner. The home is suitable for those with mobility problems. There is a decking area, outside which leads to a well maintained established garden. Within the garden there is a vegetable patch, greenhouse and fishpond. The Home is situated on the main A28 in the village of High Halden. Within the village there is a pub, church, post office and village shop. The town of Tenterden is approximately two miles away. The Home is on the bus route to both Tenterden and Ashford. The Home also has two cars, which can be used for Service Users if they wish. The current scale of fees is £1500.00 to £1615.00 per week. There are additional charges for hairdressing, magazines and newspapers and personal toiletries. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sally Gill, Regulatory Inspector, carried out this key inspection. It was carried out over a period of time and concluded with an unannounced site visit to the home on 25th October 2006 between 8.35am and 4.25pm. Two people were living at the home and both have moved to the home since the last visit. The inspector met and spoke to both plus three staff on duty. Observations included interactions between service users and staff. The inspection process consisted of information collected before and during the visit to the home. Relatives, care managers and other professionals involved in the home were contacted. All feedback was very positive. Various records were viewed during the inspection. The inspector accessed the kitchen/diner, lounge, bathroom, laundry, proposed snozelan, the office and all bedrooms. What the service does well: Admissions to the home are well planned for the service user. The home also takes care to involve families and any professionals. Service users said they liked living here, the food was good and staff could cook. They were comfortable with staff that were caring and treated them with respect. Professionals all gave positive feedback. One commented that ‘its very clean and relaxed. It’s one of the nicest homes I’ve been to’. Service users enjoy a many activities such as swimming and bowling. There are regular trips out to local places chosen by the service users. Service users live in a light and spacious home, which is very comfortable. It is very well maintained. Furniture and decoration is of good quality but also suits resident’s needs. Most have their own full ensuite. Residents are encouraged to see the home as their own. The registered manager is well thought of by service users and staff. He puts service users first at all times and is always looking to improve their quality of life. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be sure their needs will be assessed prior to moving in. Service users have a contract of terms and conditions but one these is not yet signed and agreed. EVIDENCE: The home has a detail statement of purpose and service user guide in place, which are kept up to date. The Registered Manager and a key worker visited the service users in their own environment prior to admission to assess their needs. The information was used to develop a care plan. Assessments were also obtained from professionals involved in their care. Relatives were involved in any decisions. Contracts are in place. However one is not yet agreed and signed by the service user/representative. The Registered Manager advised this should be done at the review on 14th November 2006. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are better but do not yet fully reflected service users skills, and goals. SU are involved in decision making but have the potential to participate further. Service users are given assistance, which is mostly supported by up to date risk assessments. EVIDENCE: Service users care plans have improved with some routines documented containing far better detail than previously. This level of detail now needs to cover all aspects of care. A cookery and laundry session recorded highlighted skills/staff assistance required which was good but these should be followed through into the care plan. Care plans also must be developed with the service users using a person centre approach. Care must be taken to ensure Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 10 information is kept up to date as in one instant it was clearly not and not all service users skills were included which may lead to staff doing for rather than maintaining and developing independence. Care plans should dated so that any reviews are clear. Folders should not be clutter with documents not relevant. Formal reviews with care managers are held. Discussions and observation showed service users are able to make some choices and decisions about their lives. Communication could be enhanced with advice and guidance from specialist support (Community Learning Disability Team (CLDT)), which would then aid choices and decision-making. Risk assessments had also improved. They were dated and reviewed regularly. They detailed risks and steps the step necessary to minimise that risk. However one incident report highlighted action to be taken should a risk occur but this had not been followed through into the risk assessment. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a range of regular leisure activities and opportunities to get out and involved in the local community. Service users are supported make friends and maintain family contact. Daily routines could promote further independence. Service users enjoy a varied and healthy diet. EVIDENCE: Service users have a wide range of interesting activities, which they said they enjoyed. Activities include swimming, bowling, computers, television with DVD and videos. Trips out include disco, pub night, the beach, garden centre, and Rare Breeds Centre. A one-service user also goes to college. Service users Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 12 are able to benefit from socialising and holidaying with residents from the Leo Trust. Staff are supportive of family contact and also ensure families are kept up to date with their relatives care. Relatives feedback has been good. Daily routines are flexible. Service users are evidently at ease with staff and there is good interaction. Service users have the potential to develop independent living skills and this is an area that needs to be progressed. Meals are planned weekly and judgements are made about service users enjoyment. A service user said they like the meals and that staff are good cooks. The menu reflected a good variety of food. Quality produce is source from local suppliers where possible. A healthy diet has lead to one service user losing weight. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans do not evidence personal support is given in the way that is preferred. Service users could benefit from additional input and specialist help. Health care needs are met but the records should be improved. There continues to be some improvement with regards to medication, although some shortfalls remain, which potentially place the service users at risk. EVIDENCE: Care plan do not at present evidence this is the way service users wish to be supported. The service users have the potential to be more independent than their care plans at present state. The recommended referral for advice and guidance would enable a consistent approach from staff particular to aid communication with service users. A key worker system is in place. Service users since living at the home have had annual check ups. Health care records did have gaps in the recording although staff were able to give a verbal Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 14 account. Guidance from the continence advisor has been sought. Although discussions with staff highlighted that this is a complex issue. Specific monitoring/recording may aid the management of the problem. Some improvements had been made to the medication systems. The storage of medication was satisfactory. Most administration was in order. Although a letter from the GP detailing a change in the prescription had not been pick up and implemented or questioned by the home. The home were advised to contact the GP and confirm the correct dosage. Medication details in the care plan would benefit from a start and end date. Over the counter medication must be agreed with the GP prior to administration. Currently only team leaders administer medicines. Further staff training is currently being planned/booked, which is needed. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users views are listened to and acted on. Further staff training would help to ensure service users are protected from abuse. EVIDENCE: No complaints have been received since the last visit. A complaints procedure is in place and included in the service user guide. The registered manager agreed to set up a grumbles book for service users day-to-day views. The complaint discussed at previous inspection has been investigated and appropriate action taken. An adult protection and whistle blowing policy is in place. A staff member spoken to knew where to report outside of home. However the home has not trained any staff in adult protection. Knowledge has been gained from previous employers and discussions at team meetings. Staff should be trained in adult protection. Service users finance records and balances were in order. All staff have all got an enhanced disclosure in place. One incident of aggression was highlighted but not recorded on an incident form, which it should be. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27 28 & 30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users live in a spacious, well maintained, clean and comfortable home with high quality furniture and fittings that suit their needs. EVIDENCE: Durrants Care Services is a converted barn, which has been achieved to a high standard. All bedrooms are singles and on the ground floor which is suitable for wheelchair access. Bedrooms are very spacious and one was personalised and reflected interests and hobbies. The other was sparse and the registered manager has plans to work with the service user to create a more personalised environment. One room has a full ensuite and the other has the use of a bathroom. Fixtures, fittings and furniture are of high quality and result in a very homely environment, which is comfortable and clean. Laundry facilities are being improved so that staff do not have to carry dirty laundry through the kitchen. A vacant room is intended as a snozelan. Outside there is a decking area with seating, which lead to the garden, which is well maintained. There is also a fishpond, a vegetable patch and green house, which is hoped, will be Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 17 used by the service users in good weather. Clinical waste is handled and disposed of safely. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A caring staff team support service users but improved training opportunities and formal supervision would enhance the team’s effectiveness. A robust recruitment process is followed. EVIDENCE: There are good staffing levels in place. One staff member is on duty from 8am – 9am, 2 9am – 9pm plus one member sleeps in. This is in addition to the registered manager who is not always on site as he manages another home as well. Staff were observed to be approachable and at ease with service users. Two staff have achieved Foundation in Care Management which the college advised them is equivalent to NVQ3 and another is at college undertaken NVQ level 2. This is will achieve the 50 target when completed. Staff files evidenced that robust recruitment procedures were in place. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 19 Staff have undertaken induction but not to Skills for Care specification and there are no records of the induction programme they have completed. The registered manager stated that the home is currently purchasing a Skills for Care package, which will be externally assessed. The registered manager will then signed off their competency. Staff should undertake an induction programme that is to skills for care specification. Staff would also benefit from other training highlighted in this report (medication, adult protection and infection control). It was suggested that an information manual is developed for staff on topics relevant to service users disabilities. One staff member has had formal supervision sessions, which have been recorded. Although others said they felt well supported they have not had formal supervision. New forms have been developed to aid formal supervision. Formal supervision should be a high priority given that the registered manager is not always on site. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a competent manager who put their interests first. Service users views underpin the development of the home. Records do not support care received by service users. The health safety and welfare of service users is promoted but further staff training would benefit. EVIDENCE: The registered manager has many years experience and is committed to improving the life of service users. Service users were at ease in his company. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 21 Staff said of the registered manager “Joe has good ethics and he actually cares about residents and puts them first”. The registered manager discussed his commitment to ensure staff have a full understanding of their role and appreciate the ethos of the home. The atmosphere in the home was positive, calm and relaxed. Throughout the visit it was evident that the home is run in the best interests of service users and very much inclusive of their wishes. Given both service users are new quality assurance has not been formally undertaken as yet. Although informal discussions with service users, relatives and professionals is ongoing. This will need to be formalised. A service user said they liked living here and were happy. The home has a development plan in place, which was discussed. Improvements in the paperwork have been made or are being worked on and are not yet in use. The home continues to struggle to produce effective paperwork to support the good care received by service users. Examples of this are care is delivered very much person centre but care plans are not person centred. Staff feel very well supported but there is no formal supervision or records. Four staff are trained fire awareness, first aid and food hygiene, five staff are trained in manual handling. No staff are trained in infection control which is recommended. The fire safety log book showed all tests recorded appropriately except drills. Fire drills must be recorded including the names of staff that took part. Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 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 3 3 X 4 X 5 2 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 4 26 4 27 3 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 4 3 X 2 2 X Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard YA5 YA6 Regulation 5 15 Requirement Service User agreements to be agreed and signed by them/their representative Care plans and risk assessments must be kept under review and updated as required (previous timescale 10/04/06 not met) The home must operate a safe system for medication (dosage, over the counter medicines & staff training) Fire drills must be recorded including the names of staff that took part Timescale for action 14/11/06 30/11/06 3 YA20 13(2) 25/11/06 4 YA42 23(4) 25/11/06 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 YA7 YA18 YA23 Good Practice Recommendations Seek specialist advice and guidance to aid communication, decision-making and independence All incidents of aggression should be recorded appropriately DS0000064523.V301414.R01.S.doc Version 5.2 Page 24 Durrants Care Services Ltd 3 4 5 6 YA23 YA35 YA36 YA42 Staff should be trained in adult protection Staff should undertake an induction programme that is to skills for care specification Records to be maintained regarding staff supervision sessions Staff should be trained in infection control Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 25 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 Durrants Care Services Ltd DS0000064523.V301414.R01.S.doc Version 5.2 Page 26 - 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!