CARE HOME ADULTS 18-65
Ebbsfleet House Ebbsfleet House Tubbs Lane Ramsgate Kent CT12 5DH Lead Inspector
Brenda Pears Unannounced Inspection 24th January 2006 09:00 Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ebbsfleet House Address Ebbsfleet House Tubbs Lane Ramsgate Kent CT12 5DH 01843 825226 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) High Quality Lifestyles Limited Stephen Paul Wood Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Ebbsfleet House provides support and accommodaton for 5 service users with learing difficulties. The home is a detached property in a large expanse of grounds and has been adapted to meet the needs of the current service users. There is parking to the front of the building and a large enclosed garden to the rear. The main body of the home accommodates 4 service users with a selfcontained area known as the cottage acccomodating the 5th person. Although the home is not in a central residential area, transport is available and outings and shopping trips are regularly undertaken following completion of risk assessments. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken with a focus on the well being, safety and quality of life of service users living in the home. The methods of inspecting the home included speaking to staff, reviewing documentation and touring the building. The registered manager was not on duty at this time, therefore the senior member of staff assisted with this inspection and displayed a thorough knowledge of service user needs and health care developments. The local Health and Safety Officer also called into the home during this inspection and discussions were undertaken regarding safety, risk assessments in particular, and the safety of both service users and staff during routines inside and outside the home. This report reflects the findings at this and at the previously announced inspection. One service user who had previously been assessed as requiring alternative accommodation has now moved to a more appropriate environment. This move has given Ebbsfleet House the peaceful and calm environment that was previously enjoyed by service users. Staffing levels have also become stable and this again provides a calm and familiar environment for service users. What the service does well:
There are still some staff vacancies in the home and staff are currently being recruited. When agency staff are used, these are people who are already known to service users. This ensures continuity of care and creates a secure and stable environment for those living in the home. Records show full assessment of the needs of service users is undertaken while maintaining and monitoring set goals. Risk assessments are completed prior to any activity or outing being undertaken. This ensure the correct staff numbers are allocated to support the action and to ensure the safety of both staff and service users. The home provides a safe environment in which to live, with risk assessments being completed for all activities and appropriate staff support. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 the following standard(s): 2 Individual needs, goals and aspirations are assessed and appropriately supported and reviewed. EVIDENCE: Care plans state what support is required for service users to achieve goals and aspirations. Some may be small achievements but all are recognised as attainments. Plans state what words or actions assist each person and charts show achievements and activities during each set period. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 the following standard(s): 7, 9, 10 All activities are undertaken following discussion with each service user, supporting choice and autonomy. Risk assessments support all activities and manageable risks are undertaken as part of the development process. EVIDENCE: Staff members ensure the wishes of service users are sought and that inclusion is fully supported. This is ensured by staff asking the preference of the service users and respecting the choices made. All activities undertaken or refused are recorded to assist with future planning and assessment. Risk assessments are undertaken and kept on each person’s file. Activities are all risk assessed to ensure that the risks undertaken are manageable and appropriate. Staffing levels are also dictated by the outcomes of these assessments. All staff must be made aware of the importance of records, that these are official documents and must be treated as such with due regard to the dignity
Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 10 of service users. The senior member of staff on duty at this time was unaware of this requirement from the last inspection. The registered manager must discuss the appropriate terminology and use of language that is in reports with all staff to ensure uniform recording and awareness is achieved. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 the following standard(s): 13, 15, 16 Appropriate activities are undertaken that integrate service users into the local community and that are chosen by each individual, supporting development, independence and choice. Family, friends and/or advocates are encouraged to maintain contact with service users. EVIDENCE: All activities in the community are decided through consultation with the individual and are then set out in person centred plans, with appropriate staffing levels. Activities that are undertaken include shopping trips, outings and local walks. Holidays are undertaken each year and one person chooses to have a few days away to different parts of the country and this is also supported. All relationships that are important to service users are encouraged and continued contact supported. Families are very much part of the ongoing
Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 12 process of development for individuals, with planned goals being to undertake visits to family or friends wherever possible. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 the following standard(s): 18, 19 Support is given to each service user in a way that suits the individual and all healthcare needs are appropriately met, fully supporting individual needs. EVIDENCE: Health is monitored through observation regarding food that is eaten, weight charts and behaviour patterns. There is a regular review of medication and adjustments are made as recommended. There are also charts maintained for all observations of the individual including food eaten, outings undertaken or refused. All these observations are regularly reviewed to support and inform individual assessments and to identify specific triggers to behaviours. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 the following standard(s): 22 There is a complaints procedure in place to support and protect service users. EVIDENCE: Although not directly inspected at this time, there is a complaints procedure in place to support service users and visitors to the home. Discussions and communication with service users are undertaken on a daily basis, ensuring all routines in the home are service user led and continued contact with family/friends is maintained. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 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 the following standard(s): 25, 30 The home was clean and in the main, odour free, but some areas in the home still require attention to provide a completely fresh and pleasant environment throughout. EVIDENCE: While staff undertake regular cleaning routines to keep the home as fresh as possible, odours still permeate in some rooms. The renewal of floor coverings and soft furnishings would help to eradicate this problem. One bathroom has been redecorated and has new flooring but a more comfortable environment would be achieved and maintained if there was a continued maintenance and refurbishment programme in place. Not all windows have some form of privacy screening in place. While not everyone likes curtains, some thought must be put into alternative methods of ensuring a comfortable, and cosy atmosphere is provided for each service user. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 Activities are risk assessed to ensure appropriate staffing levels are in place for all activities both inside and outside the home, supporting the safety of both staff and service users. Staff training is undertaken but not always refreshed when necessary, resulting in a possibly ineffective staff team. EVIDENCE: Discussions and communication with service users ensure activities and outings are what each individual wants to undertake. Risk assessments ensure any activity is appropriate, beneficial and safe. All activities are supported by risk assessments and appropriate staffing levels are assessed and provided. Staff on duty at this time consisted of 3 care staff plus 2 staff who undertake a ‘middle shift’ to cover any activities, appointments or outings. 2 staff were supporting 2 service users at college. Staff training that has been booked includes First Aid, Moving and Handling, Safe Administration of Medication, Food Hygiene, however, constant refresher courses must be booked to ensure all staff have a current and appropriate
Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 17 knowledge base. Refresher courses are currently not always identified or regularly booked. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The health, safety and welfare of service users are, in the main, promoted. However, some areas of the home require upgrading to ensure the provision of a comfortable and acceptable environment. EVIDENCE: The home is still recruiting for some care staff vacancies but the core staff team continues to cover all shifts, providing a stable staff group. This then provides a constant and familiar environment in which to support service users. All areas in the home are made safe for service users, locks are in place for areas containing dangerous products, cooking areas are guarded and fire exits are appropriately signed. Items around the home are protected and made safe for all service users. However, some of these precautions are in need of assessing to ensure that minor maintenance is carried out to provide a bright and comfortable living space in all areas. Attention must be paid when making
Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 19 individual rooms safe, this can result in a very clinical appearance and everyone needs to have a fresh, bright and welcoming room of their own. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 20 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 X 3 X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 2 Standard No 24 25 26 27 28 29 30
STAFFING Score X 2 X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 3 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Ebbsfleet House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 x DS0000037202.V273668.R01.S.doc Version 5.0 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA32 Regulation 18, 19 Requirement Staff to undertake training and refresher courses on a regular basis to gain the appropriate knowledge base to support service users. - Full training matrix to be sent to CSCI by the stated date. To upgrade communal and individual areas of the home to provide a more pleasant and comfortable environment. - Action plan to CSCI by the stated date. That all staff are advised of the importance of records, that these are official documents and must be treated as such with due regard to the dignity of service users. Timescale for action 06/03/06 2 YA30YA25 12, 13 06/03/06 3 YA10 17 06/03/06 Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 22 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 Refer to Standard YA13YA12 Good Practice Recommendations That there is an ongoing maintenance programme in place to maintain an acceptable environment in the home. Ebbsfleet House DS0000037202.V273668.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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