Inspection on 07/07/05 for Ebbsfleet House

This inspection was carried out on 7th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ebbsfleet House 30/06/08

Ebbsfleet House 20/06/06

Ebbsfleet House 24/01/06

Ebbsfleet House 19/01/05

Ebbsfleet House 14/04/04

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

CARE HOME ADULTS 18-65 Ebbsfleet House Tubbs Lane Ramsgate Kent CT12 5DH Lead Inspector Brenda Pears Announced 7 July 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ebbsfleet House Address Tubbs Lane, Ramsgate, Kent. CT12 5DH 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) 01843 825226 High Quality Lifestyles Ltd Care Home 5 Category(ies) of Learning Disabilities registration, with number of places Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 fornt 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 H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and the focus of this visit was to assess the health, well being and quality of life of service users living in the home. Staffing levels were also reviewed and discussed in some depth. Some concerns have been expressed regarding staffing levels on the questionnaires received prior to this inspection. The staff group has changed a great deal since the last inspection and the home are currently trying to recruit suitably experienced and trained staff to give continued support to service users. In the main, the home was found to be clean and odour free, however, some areas are in need of attention. Some small maintenance matters require attention and redecoration in rooms and bathrooms would help to improve the environment. One service user has recently been assessed as requiring alternative accommodation. This move would be a positive one for the current service users who were placed at Ebbsfleet House for the peaceful and calm environment that was offered at the time. It is hoped that this atmosphere will again be enjoyed when placements and staff are appropriate and constant. What the service does well: What has improved since the last inspection? Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 6 Reviews and assessments have been carried out for every service user to confirm that Ebbsfleet House is still the best placement. This has highlighted the difficulties with one person who is in need of an alternative placement. While this is appropriate for the individual, this will also have a positive impact on the environment for everyone living in the home. 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 H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3 The needs and aspirations of service users are assessed and recorded on care plans that underpin the support given. EVIDENCE: Care plans state what support is required for service users to achieve goals. These 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. This ensures that each service user makes advances, both large and small, in their own time and with appropriate assistance. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Care plans reflect changing needs of service users. Service users make decisions about daily life and support is given as necessary. Reasonable risks are taken where this is seen as appropriate. EVIDENCE: Each service user decides their daily routines and activities are only undertaken at the request of each individual. This was stated in daily care plans and at this time a service user did not want to undertake a planned outing. The outing was then postponed and a swimming session was undertaken. This ensures that each person is supported to make decisions and has control over their own life. Changing routines and likes and dislikes are recorded on care plans. This ensures that the correct support is given and that care plans reflect the needs of each individual at any time. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 10 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. This maintains the safety of each service user while supporting development and creating opportunities to grow as individuals. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 17 Appropriate activities are undertaken that integrate service users into the local community and that are chosen by each individual. Some activities have not been undertaken due to staff changes and shortages. A varied and nutritious diet is offered in the home to service users. EVIDENCE: Care plans show activities that have been undertaken and these are part of the local community such as shopping trips, outings and local walks. Appropriate staffing levels are in place for activities undertaken and a graph shows if activities have been maintained or if these have declined. These records then show what has been enjoyed or those that will need to be reviewed. This ensures service users are both benefiting from activities and choosing the wa they wish to spend their time. Meals are on a menu plan and all food taken is recorded on care plans. This ensures a balanced and nutritious diet is enjoyed and weight charts also Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 12 support this. Meals are often eaten out if this fits in with planned activities, again integrating service users into the local community. Due to the past increase in staff changes in the home, some activities and outings have not been undertaken. This has impacted on the quality of life for the service users. This has also caused some anxieties for both thos e living in the home and for family and friends. It is hoped that one person with particularly high needs, will soon be placed in alternative accommodation. This will impact on the life at Ebbsfleet House and create a more settled and calmer environment to ensure a better quality of life for service users. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 19 Service user support is delivered in a way that suits the individual and health care needs are being met. There is continued access to appropriate health care services that are needed to support service users and ensure their well being. EVIDENCE: Records show that health is monitored through observation regarding meals that are eaten, weight charts and behaviour patterns. Regular reviews are undertaken with allocated care managers, family, friends or advocates, psychiatric nurse, the service user and any other appropriate persons. There is a regular review of medication and adjustments are made as recommended. There are also regular reviews of behaviours with charts being completed and assessed to identify specific triggers to specific outcomes. The home recognises that some behaviours have affected the atmosphere at Ebbsfleet House and appropriate actions have been undertaken. Assessments have been completed regarding the environment and the individual needs of those living at Ebbsfleet House. These assessments have resulted in the Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 14 decision to seek an alternative placement for one person who requires a different environment to develop and obtain specific support. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 There is a complaints procedure in place. Activities are risk assessed to ensure appropriate staffing levels are in place. All incidents are fully recorded and assessed at regular intervals. Unacceptable terminology was discovered on some records. Full information is not currently recorded on incident reports. EVIDENCE: There is a clear complaints procedure in place to log a complaint. Discussions and communication with service users ensure activities and outings are what they individual wants to undertake. Risk assessments ensure any activity is appropriate, beneficial and safe. Choices were being made by service users at the time of this inspection. One planned activity was altered at the request of the service user and choices were being made with regard to lunch. While incidents are fully recorded and appropriate notification is carried out, some use of words on these was found to be unacceptable. Monitoring of all records must be undertaken and staff training carried out where necessary. Records are official documents and must be treated as such, while consideration must be given to the dignity of the service user. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 16 Records show what interventions are carried out during an incident and assessment and monitoring is undertaken, however, there is no record of whether an intervention was successful or achieved the necessary outcomes. The incorrect intervention will continue to be used if the outcomes and impact of an intervention is not assessed. This is therefore not providing a complete understanding of service users behaviour or ensuring the correct action is being taken by staff at all times that will ultimately benefit the service user. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27 & 30 The communal areas have deteriorated and are in need of attention and upgrading, particularly the first floor corridor and carpet. Rooms and bathrooms also need attention to produce a cleaner, brighter and fresher environment. EVIDENCE: When first opened, Ebbsfleet House did provide a fresh and homely environment. Although in a rural setting, the home was comfortable, warm and bright. Unfortunately this has not continued to be the case and redecoration and some minor maintenance work would greatly improve the current environment. The first floor carpet is in need of renewal. While cleaning routines try to keep this as clean as possible, the marks are too severe to eradicate and this gives a very unkempt and unclean feel to this area. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 18 While individual rooms and bathroom areas are personalised and appropriate to meet each person’s specific needs, these again have deteriorated over time. These areas also are in need of attention to give a more homely and comfortable environment. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34 & 35 Continued staff changes have made for an unstable environment for service users. While training regarding challenging behaviour is carried out by staff, basic training has not been undertaken for some time. Current recruitment is trying to ensure that appropriately experienced and qualified staff are recruited. The recruitment process does ensure that service users are protected. EVIDENCE: While current service user placements at Ebbsfleet House have been reassessed, there has been an impact on staffing levels. Staff have moved to alternative jobs and some internal promotions for long term staff have added to the unsettled and changing environment that has developed at the home. This impacts on the service users and their quality of life. Constant changes are not always fully understood by service users and this then can affect Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 20 routines and behaviours as well as impacting on the feeling of security in the home. The home is currently working hard to address this situation and the recruitment of appropriately qualified staff is being undertaken. This will hopefully help to provide a stable and strengthened staff group that will in turn provide a constant and familiar environment in which to support service users. It is also recognised that some members of staff have continued to work in the home and developed a core team that provides support to service users. Ongoing training is vital to ensure staff knowledge is current and appropriate. The core skills training such as moving and handling, first aid, fire safety and basic food hygiene have not been undertaken for some time. These are the basic skills needed for all care provision and these are also required to be updated on a regular basis. This has not been ongoing in the home and does not create an appropriately trained staff team or develop a safe environment for service users. Staff files contain appropriate documentation that supports the safety of service users. CRB checks are in place, references are obtained, a full induction programme is undertaken and medication only administered when staff have been appropriately trained and assessed. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 &42 The wishes of service users are obtained and development is reviewed on a regular basis. The health, safety and welfare of service users are promoted but some areas need strengthening. EVIDENCE: The home currently has a new manager who is endeavouring to address the staff shortages and provide a stable environment for service users. This will then provide much needed stability in the home that will positively impact on the welfare and well being of 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. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 22 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. This attention to small details will then give an overall impression of a well cared for and well maintained environment for those living in the home. Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 23 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 3 x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 x 2 x x 2 Standard No 11 12 13 14 15 16 17 x 2 2 x x x 3 Standard No 31 32 33 34 35 36 Score 2 2 2 3 2 x CONDUCT AND MANAGEMENT OF THE HOME 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 3 x x 2 x H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 24 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 31,32,33, 35 Regulation 18 & 19 Requirement Timescale for action 31/12/05 2. 24,25,27, 30 12 & 13 3. 12, 13 & 42 12 4. Staff undergo appropriate traiining on a regular basis to gain the appropriate knowledge base to support service users fully. To upgrade communal and 31/12/05 individual areas of the home to provide a pleasant and comfortable environment That staff continue to be 31/12/05 recruited to enable more activities and outings to be undertaken that integrate service users into the local community ACTION PLAN WITH TIMESCALES TO BE FORWARDED TO CSCI NO LATER THAN 31/07/05 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 12 & 13 Good Practice Recommendations That there is an ongoing maintenance programme in place to maintain an acceptabe environment in the home. H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 Page 25 Ebbsfleet House Commission for Social Care Inspection 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 © 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 Ebbsfleet House H56-H05 S37202 Ebbsfleet House V229359 070705 Stage 4.doc Version 1.30 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!