Inspection on 09/03/06 for Forestview

This inspection was carried out on 9th March 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Forestview 17/03/09

Forestview 21/03/07

Forestview 09/11/05

Forestview 02/02/05

Forestview 10/11/04

Forestview 10/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Forestview 60 Cherry Orchard Marlborough Wiltshire SN8 4AS Lead Inspector Pauline Lintern Unannounced Inspection 9th March 2006 10:00 Forestview DS0000028676.V274890.R01.S.doc Version 5.1 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 Forestview DS0000028676.V274890.R01.S.doc Version 5.1 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. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Forestview Address 60 Cherry Orchard Marlborough Wiltshire SN8 4AS 01672 512464 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) White Horse Care Trust Mrs Allyson Kim Read Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2) of places Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users that can be accommodated at any one time is 8 No more than 2 service users with a learning disability, aged 65 years and over may be accommodated at any one time The difference in age between the youngest and oldest service users must not exceed 45 years 9th November 2005 Date of last inspection Brief Description of the Service: Forest View is a spacious bungalow situated in a residential area of Marlborough. The home is registered to provide residential care to eight people who have a learning disability. The home is managed by the White Horse Care Trust and is one of a number of care homes run by the Trust. The house is furnished in relation to service users needs and offers a number of communal areas in the form of a spacious lounge, separate dining room and breakfast area within the kitchen. Service users access various outreach services and day sessions and the home has its own transport. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Service users are known as clients at Forestview. The unannounced inspection took place over four and a half hours. The manager was unavailable as she was attending a meeting, however the deputy was able to meet and provide the inspector with access to documentation, which included care plans, risk assessments and health and safety records. The inspector met with clients and a number of staff members during the day. What the service does well: 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. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 6 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 Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 7 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 Files demonstrate that prospective clients’ individual needs are assessed prior to being offered a service. EVIDENCE: Three client files were sampled and each contained an assessment which was completed prior to being offered a service at Forestview. One client’s assessment stated that the client was unable to contribute to the assessment due to communication difficulties. Areas assessed include mobility, behaviours, risks, finances, leisure, family involvement and personal care. Specialist involvement has been considered such as input from psychiatrists, community nurse and the GP. Clients who would benefit from advocacy involvement are also identified. Each file includes a copy of their contract, statement of terms and conditions and their rights and responsibilities, which is also available in a pictorial format. Each person has a guide to living at Forestview. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 8 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): 6, 9 and 10 Clients who are able to verbally communicate are encouraged to participate in the development of their care plan. Risks are assessed to enable clients to live as independent a life as is safe. Clients are informed of how information about them is handled and stored. EVIDENCE: During the inspection three clients’ care plans were sampled. Each contained a review calendar, which enable the reader to identify the review dates planned for the following twelve months. There is evidence that regular reviews also take place for the individual support needs of clients. There are clear behaviour indicators and a management support plan for staff to follow. Some clients have input from the psychiatrist and community nurse to offer support and guidance for the staff team. Client plans include information on eating, choking, health needs, mobility, personality, likes and dislikes and potential hazards within the environment. Forestview has robust risk assessments in place, which show that they are regularly reviewed. Risk assessments are both generic and individual. When sampling the files it was noted that a couple of clients have their toiletries locked away in their bedrooms for their safety, it is recommended that a risk assessment be completed to support this restriction. When touring the Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 9 grounds the deputy explained that the garden gate is locked, as there is a possibility that some clients may abscond, again it is recommended that a risk assessment be completed to support this decision. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 10 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): 12, 15 and 16 Where possible, staff members enable clients to take part in appropriate activities. Contact with families and friends is encouraged. Clients were observed being treated with respect. EVIDENCE: Staff report that clients attend College and various resource centres, where they have the opportunity to do various activities. One client had successfully completed a course on ‘learning to choose staff’ and also ‘skills for life’ the certificates are displayed on their bedroom wall. One client is presently completing a course in media studies at Wyvern College. Other activities, which are enjoyed, are walking, pub visits, eating out, the zoo, feeding the ducks and shopping. Clients supported by staff frequent local shops. One client enjoys music and sing-along at the home. Generally staff report that the clients are welcomed into the local community. One client maintains old relationships through the resource centre. Indoor activities include knitting, watching television and videos, sewing, drawing, jigsaws, finger puzzles and helping with vacuuming, dusting and cooking. One client attends a ladies session where they have the opportunity to have Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 11 manicures etc. One client is very keen on horse riding and staff support them to attend on a regular basis. Examination of care plans show that client’s cultural needs have been considered when completing their assessment. During the inspection one client received a surprise visit from a family member. Staff were observed making them feel welcome and giving them space and time to spend with the client. One client has their cousin acting as their advocate. At Christmas some clients visited their families for the day. One care plan showed that one client prefers to use an alternative name. Staff were observed using this preferred name when addressing them. The deputy reported that due to the complex needs of the clients at Forestview no one is able to hold their own key. The issue of restriction is covered in standard 8 of this report. The deputy reported that one client does not like to spend time alone in their room, preferring the company of the staff and their peers, whereas another person likes to go into their room to watch their videos. Clients are encouraged to make choices where possible. Staff report that some clients will ask to go to the pub or shopping, whereas some people cannot make verbal choices. Staff demonstrated to the inspector that they have a good knowledge of the client’s likes and dislikes and often decisions are based on this. The deputy reported that two client’s prefer to eat their meals separately and whilst the majority eat in the dining room, they take their meals in the kitchen. During the inspection staff were seen to be interacting with the clients and not exclusively with each other. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 12 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 and 21 Clients’ personal care needs are being met. Ageing and death is handled with sensitivity. EVIDENCE: There was evidence in clients’ plans to indicate that preferred personal care support are met. They show the extent of support that an individual requires, encouraging them to be as independent as possible. One client prefers to take a bath instead of a shower and likes the water to be quite hot. This is recorded and a risk assessment provides guidance for the staff. Some clients need to use a bath chair hoist to get into the bath, however the deputy told the inspector that they are soon to have a new ‘Parker’ bath installed which will be easier to use for both the clients and the staff. It was noted that the chair hoist was last serviced on 21/9/05. All clients have their mobility assessed and the results are recorded in their plans. One care plan explains that the one client is able to wash their upper body with out support but needs assistance with putting toothpaste on their toothbrush. All personal care takes place in the privacy of the bathroom or the bedroom. Clients are encouraged to make choices of which clothes to wear. One person prefers to wear loose clothes and trousers and will pick their daily selection. They also like to wear jewellery daily and will make their own choices on which item to wear. Times for getting up and going to bed are flexible. The deputy Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 13 reported that one client often chooses to sit in the lounge rather than go to bed. Clients’ support needs are regularly reviewed by the GP and the Community nurse, if appropriate. These reviews are included in the review calendar to ensure they do not get missed. Each individual plan has the client’s routines clearly detailed and these are also revised regularly. The sensitive subject of death and dying is covered in clients care plans. They detail the clients understanding around death and any specific requirements requested by the client or their family. Some clients have funeral plans in place, arranged by their families. One individual’s care plan shows that staff had discussed death with them, when a close family member had passed away. This showed that it had been addressed in a sensitive and appropriate way. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not inspected during this cycle. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 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): 24 and 30 Forestview presents itself as a homely, comfortable and safe environment. At the time of the inspection all areas were clean and hygienic. EVIDENCE: When the inspector arrived at 9.30am, some clients were having their breakfast and some were going through their morning routines. The home appeared clean and tidy and there were no unpleasant odours. After breakfast the kitchen area was cleaned and the floor washed. All bathrooms and toilets were of a high standard both in cleanliness and fittings. The lounge and dining area are spacious and there is a homely feel to them. Clients were seen to access all areas of the house, one person doing puzzles in the dining room whilst others relaxed in the lounge. The home has adequate wheelchair access to enable clients to manoeuvre easily. On the lounge walls are exhibits of craftwork that has been completed by clients giving it a personal feel. A tour of the building showed that bedrooms are clean and tidy and furnishings and fittings are appropriate to the individual. The garden is secure (see standard 8) and the deputy confirmed that clients do access the area in the summer. The home is in keeping with other houses in the vicinity. A gardener keeps the garden in good order and the home has a maintenance manual to record jobs identified that need completing. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 16 The home has a large garage which houses the freezer, tumble drier, staff lockers and a locked cupboard for all toxic materials. There is also a laundry, which is fit for purpose with another tumble drier and a washing machine in it. Staff attend infection control training and the home has a copy of Wiltshire’s guidance on infection control. The deputy reported that all soiled waste is no longer collected it is now required to be placed directly into the normal refuse bins. Staff are provided with protective clothing, such as aprons and gloves to reduce the risk of infection. The laundry area was clean and hygienic at the time of the inspection. Bathrooms and toilets contain facilities for staff to wash their hands with bacterial wash. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 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 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, 34 and 36 Whitehorse Care Trust provides staff with training to enable them to be competent to meet clients’ needs. The homes recruitment practices promote the protection of clients. Staff receive regular supervision and appraisals. EVIDENCE: Discussion with staff members indicates that staff have a good knowledge of individuals disabilities and specific needs. Training is provided in specialist subjects such as epilepsy and nutrition. Staff confirmed that they have found this interesting and useful. One staff member who has been employed for five months confirmed that they had received an induction period and had attended training for first aid, manual handling and basic food hygiene. The inspector observed the induction programme, which takes place over a two-week period and covers areas such as first aid, fire, basic food hygiene, and manual handling. After a six-month period staff have a review of their performance. Staff complete training within the LDAF system, which helps provide them with evidence, which can be carried over to their NVQ when they start them. One staff member who spoke to the inspector confirmed that they had attended training courses and was always informed when it was necessary to complete a refresher course. The home has a training programme for 2005/06, which showed various subjects were being offered to staff. The deputy commented that she has her NVQ level3 along with another member of staff. Two other staff members have completed their level 2. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 18 Following a recommendation at the last inspection, CRB records were sampled. They demonstrated that records are now kept of the dates CRB checks were returned, their individual numbers and the date when they need to be reviewed. As the manager was not available the inspector was unable to access staff recruitment files during this inspection, however this standard was covered at the last inspection and showed to be satisfactory. Staff confirmed that they receive regular supervision with either the manager or the deputy. The inspector sampled supervision notes and they evidenced that supervision takes place on a regular basis. Supervisions identify any training needs that the staff member may require. Staff have annual appraisals and the notes are kept in with their supervision notes. The home has three staff working on the morning shift and four on the afternoon. There is one sleep in staff and one waking night. Staff told the inspector that they felt adequately staffed to meet the needs of the clients. The home has policies and procedures in place for dealing with physical aggression towards staff. Training is provided for staff for physical intervention, this is followed with yearly refresher courses. The deputy confirmed that physical intervention is rarely used at Forestview as the staff have a good recognition of clients’ triggers to behaviours and are able to use distraction techniques. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 19 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): 39 and 42 Where possible clients’ and their families have the opportunity to feedback their views on the service provided by Forestview. The health and safety of clients is generally promoted and protected. EVIDENCE: Records show that a quality audit has been completed for 2005, which looked at a number of National Minimum Standards. A quality satisfaction survey sent out by the home to clients and their families only received 3 replies, however all contained positive responses. The survey was also sent out to staff and received 100 responses. There is evidence that a Residents Consultation meeting took place on 16/11/05 and the minutes indicate that clients contributed to the meeting. Forestview has a training and development plan for 05/06. Health and safety files were examined and showed that all mandatory training is provided and refresher courses arranged when necessary. Staff confirmed that they have attended manual handling, fire, first aid and basic food hygiene training. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 20 Sampling of fire systems showed that generally they are all up to date. It was noted that the fire drill practice is due to be completed before the end of March 06. Tests for Legionella took place on 24/12/05 and the portable appliance test (PAT) has been completed. The home has a health and safety manual, which contains procedures for food hygiene, accident reporting, RIDDOR, COSHH, infection control, safe systems and personal protective equipment. The deputy confirmed that waking night staff records water temperatures daily, following a recommendation made at the last inspection. The accident reports were examined at the inspection and are all filed appropriately. Staff reported that they had all completed an induction period and felt that their manager and the deputy adequately support them. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x x 3 x x 3 x x 3 x Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 22 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. 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 YA42 YA9 YA9 Good Practice Recommendations It is recommended that the manager ensure that the fire drill is completed before the end of March 2006. It is recommended that there is a risk assessment for the locking away of toiletries and razors. It is recommended that there is a risk assessment for the restriction of access via the garden gate. Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Forestview DS0000028676.V274890.R01.S.doc Version 5.1 Page 24 - 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. 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