CARE HOME ADULTS 18-65
Eldermere Knowle Lane Shepton Mallet Somerset BA4 4PF Lead Inspector
Justine Button Unannounced 19th July 2005 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. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Eldermere Address Knowle Lane Shepton Mallet Somerset BA4 4PF 01823 423126 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) Somerset County Council (LD Services) Michael John Porter Personal Care Home Only 6 Category(ies) of Learning Disability registration, with number of places Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users may be admitted who have concurrent sensory impairment. Date of last inspection 31st January 2005 Brief Description of the Service: Eldermere is a home providing care and support for six adults who have severe learning difficulties, multi-sensory and physical impairments. In addition, a high level of support is required in communication needs. Eldermere is a large detached property, with secure gardens at the rear. It is set in a rural location 2 miles from Shepton Mallet. The accommodation is arranged on two floors and includes single rooms for all. Some alterations have been made to the property to meet the needs of the service user group. Service users have access to the homes shared transport. A team of staff throughout a twenty-four hour period supports the people who live at Eldemere. Staff also provide support in maintaining links with families and the wider community. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted on the 19/07/05 by one inspector. Mr Porter, the home manager, was available on the day of inspection. As this inspection was unannounced not all the standards were assessed on this occasion. Six people were living at the service on the day of the inspection. The inspector would like to thank the residents and staff for their time and hospitality shown to the inspector during her visit. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. Records examined included care plans, duty rotas, staff training and some health and safety records. Other records will be examined at subsequent inspection visits. A tour of the building as carried out on this visit. What the service does well:
This is a relatively small service accommodating only six people. This allows the service to offer domestic style accommodation and lifestyle. Due to the small number of people living at the service staff are aware of individual’s needs. The people who live at the service have lived at the home for a number of years and appear to be content with the care and support afforded to them. People who live at the home are supported by staff to take an active part in the day to day running of the home such as laundry, cooking and cleaning. A number of people who live at the service have been supported by staff to take a holiday. For those that have not there are plans to initially support them to have an over night stay away from home. If this is successful then a holiday will be arranged. The staff group is extremely stable and all staff spoken with stated that they were very happy working at Eldermere. There is a good team spirit within the home. The home was clean and tidy on the day of inspection. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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 Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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) These standards were not assessed on this occasion. EVIDENCE: Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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) 6,7,8,9,10 All people who live at the service have a plan that on the whole informs staff of their individual care and support needs. It could not be assessed if the people who live at the service are involved in the development or review of their plan. People who live at the service are involved in the day-to-day running of the home. Information is stored in a secure manner. EVIDENCE: On the day of inspection three care and support plans were viewed. The plans had not been reviewed in September 2004. Due to this timescale it was difficult to assess if the information contained in the plans was still relevant, although staff stated that the care and support needs of the majority of the people who live at the home have not changed. There was no evidence to demonstrate that the people who live at the service are involved in the development or review of the plans, although it is appreciated that this may be difficult in all cases. For one individual there were no specific guidelines on how staff should deal with some behaviours. The development of these guidelines would aid the consistency of approach by staff. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 10 People who live at the home are supported by staff to complete some basic household tasks including laundry, cooking and cleaning. The degree to which the people at the home complete this is dependant on assessed ability. Appropriate risk assessments are completed for all activities. The planned development of communication systems will enable people to have an increase role in the day to day running of the service. Staff are currently working on increasing involvement in the grocery shopping. Pictures of meals and the ingredients that they are made up of are being taken. These will then enable people to plan a menu compile a shopping list and to recognise what is required in the supermarket. This work is welcomed and will increase the independence of people who live at the service. Communication boards are also being developed for two people at the service. These boards will remind those who use them of the planned activities for the day and who is going to support them in completing these. The nature of people’s disabilities means that input into the development of policies and procedures is not generally possible. Information is handled and stored in a secure manner. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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) 11, 12,1 3, 14, 15, 16,17. People who live at the service have access to leisure activities although these can be limited. Relationships with family members are supported if this is appropriate. Service users rights are respected. A healthy diet is provided. EVIDENCE: Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 12 People who live at the service are supported by staff to access activities. These however tend to be going for walks, picnics or going out on the transport which is provided by the home. Consideration needs to be given to increasing the range of activities available. Those, which involve meeting other people or peers, may well be beneficial. One person who lives at the service does access swimming on occasions, which she enjoys. These type of activities should be offered on a more formal basis to those who enjoy them. One person who lives at the home has not recently been able to tolerate going out in places were there are other people. There are plans for this person to now start accessing activities again. Guidelines should be made clear to staff on how this should be implemented and should form part of the care and support plan. As previously stated service users with the support of staff are responsible for the day to day running of the house including cleaning, laundry and shopping. This is tailored to the individual abilities of each service user. This promotes independence and choice. The garden provides a secure area, which provides area and is freely accessible to the service user group when the weather allows. Several of the people living at the home have enjoyed a holiday recently. There are plans to extend this to those who have not yet experienced this. There was documented evidence of visits from family members. Lunch was viewed on the day of inspection. The meal was chicken Kiev new potatoes and vegetables. All those who ate the meal appeared to enjoy it. Menu’s demonstrated that a balanced diet is maintained. The development of communication systems and involvement in the planning and preparation of meals as previously discussed will be welcomed. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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, 20 The health of service users is maintained and promoted. Medication is well managed. EVIDENCE: People who live at the service visit the GP as and when required, staff give support when needed. Specialist support with regard to various support needs is sought on a regular basis e.g. psychology, speech and language and dietician. Service users key worker arrange visit to the dentist and other appointments when needed. All visits to all services are well documented in the service user plan. The service users at Eldermere have complex needs and staff appear to be well informed of all aspects of service users support needs Somerset county council has in place a policy with regard to the handling of medication. All medication is stored and administrated in lie with this policy. Provision is made for those service users are able to self medicate although this is not applicable at this time. The pharmacist visited the service on the 25/04/05 several recommendations were made at this visit. It could not be confirmed if these had yet been implemented.
Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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 standard(s) 24, 25, 26, 27, 28, 29, 30 Eldermere is clean and tidy. The home is suitable for it’s stated purpose. EVIDENCE: A tour of the building was completed during the inspection. All service users are accommodated in single bedrooms. The bedrooms are safe, comfortable and clean. The furniture and fittings in the bedrooms also meet the needs of the individual. Each bedroom has sufficient storage space. All bedding, curtains and floor covering showed individuals tastes and were of a good standard. Individuals are able to individualise their rooms and all contained personal possessions and belongings including pictures, music systems etc. All bedrooms have views of the surrounding countryside. All windows are fitted with restrictors. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 16 The bathrooms at the service have recently been refurbished. The flooring and wall coverings have been chosen with care, are easily cleaned and robust. Recommendations made at the last inspection with regard to the bathrooms have been met. There is a range of communal space available including lounge/ dining area and kitchen. Again all areas were clean and tidy. In addition there is a small activities room. Fixtures and fitting are homely in design. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 17 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, 35, 36 The service is staffed in adequate numbers. Staff are clear about their roles and responsibilities. Staff feel adequately trained to fulfil their role. EVIDENCE: Staff spoken to during the inspection stated that they felt that the service was staffed in adequate numbers. All staff saw that the well being of the people who lived at the service as their main role and responsibility. Several stated that they had received recent training and all stated that they felt that they had received adequate training in order to fulfil their role. Staff training records were viewed. Three staff are currently undertaking an NVQ qualification. Only one staff member currently has a first aid certificate. This needs to be increased to a level that would allow a first aider to be available on each shift. Although medication is stored and administered in a safe manner consideration should be given to accredited drug training for al staff who handle medication. All staff stated that they felt well-supported and received regular supervision from the home manager. Observation of conversations demonstrated that staff and the people who live at the service have a good relationship and there appears to be a good team spirit within the staff group. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 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 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) 38, 42 43 The service is well run and benefits from an accountable management system. The health and safety of the people who live at the service is well maintained. EVIDENCE: Everybody who was spoken to during the inspection stated that they felt that the manager Mr Porter was approachable and supportive. All stated that they would be able to discuss any matters of concern. Somerset County Council also have a clear management system. Some health and safety records were viewed and these were well maintained and in good order. Risk assessments are completed for both the building and individual activities. These have been reviewed recently. Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 19 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 x x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 2 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Eldermere Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 3 3 D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA6 YA7 Good Practice Recommendations It is recommended that behavioural guidelines for the identifed indivdual are incorporated in to the service user plan That service users are involved in the devlopment and review of the service user plan It is recommended that communication methods continue to be developed inorder that service users can make informed choicesand be involved in decision making. These need to be used consistently by all staff. It is recommended that the range and diversity of activites be extended It is recommended that all staff who handle medication accredited training. It is recommneded that staff first aid training in number that will allow one first aider to be on duty at all times. 4. 5. 6. YA11 YA20 YA32 Eldermere D53 - D02 S29566 Eldermere V238893 190705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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