Inspection on 08/06/05 for Elm House

This inspection was carried out on 8th June 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

Elm House 10/07/08

Elm House 25/01/08

Elm House 23/01/07

Elm House 14/02/06

Elm House 20/01/05

Elm House 21/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 192 Wivenhoe Road Alresford Colchester Essex CO7 8AH Lead Inspector Gaynor Elvin Unannounced 8 June 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. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 192 Wivenhoe Road Address Alresford Colchester Essex CO7 8AH 01206 824443 01206 824443 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) Partnerships in Care Ltd Ms Nicola Jane Rabey Care Home (CRH) 3 Category(ies) of Learning disability (LD), 3 both registration, with number Learning disability over 65 years of age (LD(E)), of places 1 Male 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 3 persons of either sex who fall within the category of learning disability. 2. The home may accommodate one named person, aged 65 years and over, falling within the category of learning disability. 3. The total number of service users accommodated in the home must not exceed 3 persons. 4. The home may provide assistance to one additional person during the day in order they may use the rehabilitation kitchen. The staff member assisting this person must be additional to staff provided in the home. Date of last inspection 20/01/2005 Brief Description of the Service: 192, Wivenhoe Road is a registered care home providing accommodation for three people under the age of 65 years who have an acquired brain injury. A variation to the condition of registration has been given for one named service user who is now over the age of 65 years; the home was still able to meet his assessed needs. It is one of two homes in the area owned by Partnership in Care, which is now part of the Sinven organisation. The Registered Manager, Ms Nicola Rabey, manages both homes. The home runs two programmes of care: one for community rehabilitation and the other being long term supported living assistance for service users requiring maintenance of their rehabilitative state, who may also have behavioural problems, which can be managed within the home. 192 Wivenhoe Road is a detached house situated on the outskirts of the village of Alresford, approximately five miles from the town of Colchester. The home is within walking distance to the village amenities, which include a shop, pub and train station. Single room accommodation is provided, two of which have en suite facilities, one with a bath the other with a shower. The communal bathroom has a shower. The home has a comfortable, safe and fully accessible dining room, lounge and sitting room for shared activities or private use. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on one day in June 2005, over 3 hours. The inspection process included an informal discussion with the manager, an interview with two members of staff, observation and examination of records and documentation. The service users accommodated at Wivenhoe Rd have sustained an Acquired Brain Injury (ABI) and have varying degrees of permanent cognitive disability following the early stages of recovery. This includes changes in concentration, awareness, perception and insight and, in some cases, long term and/or shortterm memory loss. Discussion with the service users regarding care delivery was not appropriate. However, during this and previous inspections, the service users looked well cared for and from observation of their body language and behaviour, it was clear they had a good relationship with the care staff. What the service does well: What has improved since the last inspection? What they could do better: The home must develop a process for looking at and measuring the quality of the care being provided for the service users within the home. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 6 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. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - 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 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - 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 & 4. The home operates a thorough pre-admission process, giving care and attention to ensuring the home is admitting individuals whose entire assessed needs could be fully met. The home promotes the opportunity to visit the home as an essential part of the admission process. EVIDENCE: The service has not admitted any new service users since the last inspection. Previous inspections commended the service for its thorough, comprehensive pre-admission process, which met the intended outcomes for prospective service users. Wivenhoe Road operates a graded admission policy of visits in progressive duration, covering introduction and compatibility with other service users and orientation to the home and staff. The home does not admit unplanned or emergency admissions. The home’s manager and the multidisciplinary team, together with the service user and/or their relative and/or advocate, carried out pre-admission assessments, which also included assessments from various specialists. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - 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 were service user focused, developed according to needs, including rehabilitation process and achievable goals, and care and maintenance of health, lifestyle and well being. Service users were supported within an individualised risk management. EVIDENCE: Staff spoken with demonstrated a full understanding of each service user’s needs and the importance of maintaining thorough and explicit care plans, to ensure a consistent approach in the delivery of support to the individual with an ABI, to develop and maintain their rehabilitative state. Care plans were linked to the Care Programme Approach (CPA) and the home worked in partnership with the multidisciplinary team, the service user and/or relative/advocate enabling care to be delivered in an agreed organised way. Regular reviews were carried out to determine effectiveness of the rehabilitative programme, update goals or look at alternatives. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 10 Comprehensive risk assessments were evident in each service user’s plan with clear risk management strategies to reduce potential risks that individuals with an ABI face on a daily basis, due to impaired memory and concentration. Any infringements and limitations to service user’s choice were made through the assessment process and in the service user’s interests to prevent harm to themselves and others. This was recorded in the service user’s Plan, documented under Article 8 of the European Conventions on Human Rights, together with a signed opinion of the Neuro-Psychiatrist, based on medical evidence that the service user did not have the mental capacity to make informed choices. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - 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) 11, 13, 15 & 16. Service users were given the opportunities and support to maintain and develop social, emotional, communication and independent living skills in and outside the home. Family and friends links with the service were strongly encouraged and well developed. The home offered opportunities to establish a structured and purposeful lifestyle, respecting service users’ rights and choices. EVIDENCE: Cognitive problems restrict prospects for individuals with ABI of returning to previous employment, training or lifestyle. Two service users were being supported in maintaining their rehabilitative state following recovery. One service user was on the community rehabilitation programme, looking towards a more independent outcome and is participating in a computer course, media course and independent living course specific to people with ABI. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 12 The staff spoke of the importance of daily routines and their role supporting service users through planned individualised daily programmes of simple activities in and outside of the home, to maintain and improve functional performances in every day living skills. From care review documentation it was evident service users were facilitated to make decisions with regard to their own life. Freedom of movement within the home was observed and staff were observed giving support to service users to make choices insofar as was practicable to exercise control over their life in accordance to their risk management plan. It was evident the home viewed community access and inclusion essential to the rehabilitative process and was incorporated in accordance with the service user’s assessed needs and individual plan. Service users were supported on a one to one basis by staff in the community and this was observed during the inspection. During discussion, the manager indicated that the service strongly encouraged family links and adopted a partnership approach with family members, which was paramount in increasing chances of successful rehabilitation. The home offered support to families in adapting to new circumstances. Important dates were recorded in individual care plans for the staff to support the service users in maintaining links with family and friends on birthdays and anniversaries 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - 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. The service users were looked after well in respect of their healthcare and personal needs. Staff engaged positively with each individual and demonstrated a good understanding of the service users they were supporting and treated them with dignity and respect. EVIDENCE: Respectful and helpful interaction was observed between the staff and service users. One service user had recently developed diabetes. The home had joined and accessed current guidelines from Diabetes UK to ensure appropriate management and care is provided. The service user was supported in regularly accessing the diabetic clinic, the chiropodist and the optometrist for monitoring and detecting any potential complications. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 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) 23. Care staff were familiar with the practices in place to promote the protection of service users from abuse. EVIDENCE: The home’s policy and procedure for the protection of vulnerable people was the first policy to be reviewed by the home’s new review group. The staff have devised an easy to follow flowchart procedure for easy guidance; incorporating updated information and guidelines from the four-booklet package received from Essex Vulnerable Adult Committee (EVAC). Staff have received in-house training with regard to these issues and the manager is securing places on the EVAC organised training. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 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 & 30. The home presented a clean, comfortable and homely environment, domestic in scale, well maintained and suitable to meet the service users’ needs and lifestyles. EVIDENCE: A full inspection of the premises was not made on this occasion. However, the areas visited presented a clean, safe and homely environment. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35. The home had adequate staffing arrangements to meet the service users’ needs. The care staff received sufficient information and appropriate training to support the service users. EVIDENCE: The home had made positive progress in recruiting additional staff since the last inspection and appropriate induction arrangements were in place. Two care staff and the manager were on duty, supporting three service users. Staff indicated that development and opportunities to learn new skills had greatly improved since the implementation of the in-house competency framework, a learning programme linked to service aims and service users’ needs. Enabling staff to broaden specific skills required for supporting service users on specific rehabilitation programmes. The programme is commenced following successful completion of NVQ level 2 in care. The manager stated that the competency framework is self driven, linked to a pay structure and initiated to develop and retain a highly skilled 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 17 specialised staff team to promote and maintain quality care outcomes for the service users. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 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) 37, 38, 39 &40. Staff and service users benefit from an open, supportive and knowledgeable management approach. The manager has a clear vision for improving service users’ quality of life but needs to develop a system to monitor and review quality outcomes. Records, policies and procedures were well maintained and up to date to safeguard service users. EVIDENCE: The Registered Manager holds a management qualification and NVQ level 4 in Care and has secured a place to complete additional required modules to complete the Registered Managers Award. Staff spoke well of the support they and the service users received from the manager. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 19 The manager continued to demonstrate a positive and pro-active attitude towards the development of the home. A Policy Review Group had recently been introduced, meeting monthly to review the home’s operational policies and procedures, giving the opportunity for staff to be involved in their development and ensuring they understand and apply them in practice. The home had still not progressed in addressing quality assurance and qualitymonitoring systems, as required in the last inspection report, to look at care practice and outcomes for the service users. 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 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 3 3 x Standard No 22 23 ENVIRONMENT Score x 3 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 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 x 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 192 Wivenhoe Road Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x x x I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 21 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. Standard 39 Regulation 24 Timescale for action The Registered Manager must 1st ensure effective quality September assurance and quality monitoring 2005. systems are in place. This requirement was not met within the previous given timescale of 31st March 2005. Requirement 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 Good Practice Recommendations 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Fairfax House Causton Road Colchester Essex, CO1 1RJ 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 192 Wivenhoe Road I56-I05 s17727 192 Wivenhoe Road v227973 080605 - stage 4.doc Version 1.30 Page 23 - 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. 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