Inspection on 21/07/05 for Forton House

This inspection was carried out on 21st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forton House 31/03/08

Forton House 20/06/06

Forton House 08/02/06

Forton House 09/03/05

Forton House 27/07/04

Forton House 24/02/04

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 Forton House 3 St Johns Road Exmouth Devon EX8 4BY Lead Inspector Vivien Stephens Unannounced 21 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. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Forton House Address 3 St Johns Road, Exmouth, Devon EX8 4BY 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) 01395 222621 Devon Partnership NHS Trust post vacant pending appointment of new manager Care Home 3 Category(ies) of LD - Learning disability (3) registration, with number of places Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 15.5.2002 Age range 18 to 40 years Date of last inspection 09/03/2005 Brief Description of the Service: Forton House is registered to provide residential care for up to 3 younger adults who have learning disabilities. The property is a detached family style house situated in a residential suburb of Exmouth. There is ample parking on site, and good-sized gardens.There are 3 bedrooms on the first floor, one of which is used as an office and sleeping-in room. There is also a bathroom and separate toilet. On the ground floor there is a lounge, separate dining room, a bedroom, and a kitchen. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection began at 10am and finished at 12.30pm. Two residents were at home, cared for by one permanent member of staff and one agency member of staff. One resident was on holiday accompanied by three members of staff. Since the last inspection Kevin Brooks, manager has left. The home is temporarily managed by Hugh Akiba-Jones until a permanent manger is appointed. What the service does well: What has improved since the last inspection? In recent months two residents have been moved to new bedrooms. Their new rooms have been redecorated and furnished and now appear bright, comfortable and homely. One of the former bedrooms is now a lounge, and this room also has been decorated and refurbished. A new entrance gate has been installed and this has significantly improved the security of the home, and at the same time providing a sturdy and good quality entrance to the premises. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 6 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. Forton House D54-D06 21938 Forton House 227581 210705 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 Forton House D54-D06 21938 Forton House 227581 210705 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) These standards were not relevant at this inspection. EVIDENCE: The three residents have lived at Forton House for many years. There have been no new admissions in the last year and it is unlikely there will be any new admissions in the foreseeable future. Trust Residential Services have a comprehensive admissions policy and good information is available as and when any new admission might be considered. Forton House D54-D06 21938 Forton House 227581 210705 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, 8, 9, 10 Satisfactory care plans are in place giving basic instructions to staff. These could be improved by providing greater detail of good care practice. Residents are consulted and supported by the staff team to help them lead their lives as they wish. EVIDENCE: Detailed care plans were in place for each resident and include goals and risk assessments. They have been regularly reviewed. While the care plans cover all aspects of needs, the possibility of expanding them was discussed with Hugh Akiba-Jones. Examples of good practice and successful methods of helping residents were given by staff but this level of detailed information was not included in the care plans. The care plans should be developed in consultation with the whole staff team, families and other professionals in order to ensure consistency of good practice and clear methods of achieving the action plan. Staff talked about how they support the residents and how they respected their personal preferences and wishes while at the same time encouraging them to maintain safe and healthy lifestyles. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 10 Each resident has their own weekly programme of activities based on their individual interests and preferences. Residents are encouraged to participate in the daily life of the home, helping with such tasks as laundry, cooking, shopping and gardening. Care plans and personal information is held securely in the office, which is locked when not in use to maintain confidentiality. Forton House D54-D06 21938 Forton House 227581 210705 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, 13, 14, 15, 16, 17 Residents lead active lives according to their individual interests and preferences. They are well supported by staff to take part in the local community, and to keep in touch with families and friends. Menus are varied and include fresh fruit and vegetables. Residents would benefit from a greater emphasis on home-cooked meals and greater attention to individual dietary needs. EVIDENCE: One resident attends the local Social Services day centre for specific sessions during the week. All three residents have weekly planners outlining their preferred activities. These include shopping trips, picnics, walks in the local area, car trips and individual leisure interests such as puzzles, sport or gardening. One resident particularly enjoys going out and about in the local community and meeting old and new friends. All of the residents have good contact with their families. Families are encouraged to visit regularly, and staff will also take residents to visit families. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 12 Staff talked about how they support the residents. Their responses demonstrated their respect for the rights of each resident. Examples of respect were shown in times of rising and going to bed, in expressions of mood, and of sexuality. A menu plan was displayed in the kitchen. This showed that residents make individual choices over breakfast and midday meals. Every Sunday residents have a roast dinner and during the week the menus were varied. A number of meals include processed shop-bought meals such as pizzas rather than homemade meals. The vegetable basket in the kitchen held a good selection of fresh vegetables, and residents are encouraged to eat salads and fresh fruit on a regular basis. Staff are aware of residents’ individual dietary needs and talked about how they try to gear diets to individuals, but there was limited evidence in the care plans and menus of how this is achieved. Forton House D54-D06 21938 Forton House 227581 210705 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 20 Staff provide support to residents in a way that respects their privacy and dignity. Health care needs have been well met generally. However, the use of agency staff at night, who have not received training in the emergency administration of medications is unsatisfactory. Medications are held securely and administered appropriately. EVIDENCE: Staff gave examples of how they help residents with personal care needs in a way that respected their dignity. Care plan files gave evidence of regular support provided by health care specialists. Staff have received training on specific health related tasks. None of the residents are able to retain or administer their own medication. The home uses a monitored dosage system. Medicines are held in two separate locked cabinets. Records showed that staff have administered medicines as directed. Permanent staff have received training on the administration of emergency medications. However, agency staff have not received this training and are instructed to dial 999 if emergency medication is required. The protocol for administration of emergency medication has been provided by specialist health care staff. Forton House D54-D06 21938 Forton House 227581 210705 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) This standard was not inspected. EVIDENCE: This standard was not inspected. Forton House D54-D06 21938 Forton House 227581 210705 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) 23, 24, 25, 26, 27, 28, 29, 30 The home has been well maintained and furnished throughout. The home provides adequate space and facilities to meet the residents’ needs EVIDENCE: Forton House is a detached house situated in a residential area of Exmouth. There are good sized gardens and car parking on site. The property has been regularly maintained and recently decorated throughout. Each resident has their own bedroom that is above 12 square metres. Bedrooms have been decorated and furnished according to individual interests, needs and preferences. Two residents have recently changed their bedroom, and staff talked about how this has improved their lives. The lounge and dining room are comfortably furnished and provide flexible space for a variety of activities. There is a bathroom and separate toilet on the first floor and a toilet on the ground floor. All areas of the home were clean and free from any odours. Forton House D54-D06 21938 Forton House 227581 210705 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) 31, 32, 33, 35 Staffing levels are satisfactory in relation to the needs of the residents. The use of agency staff who have not received training in the administration of emergency medication may place the residents at risk. EVIDENCE: At the time of this inspection there were two members of staff on duty. Two residents were at home and the third resident was on holiday escorted by three members of staff. Staff rotas showed that during the day there are usually three staff on duty. At night there is one waking night staff. There is a vacancy for a full-time member of staff plus additional night duty hours. Arrangements to provide waking night staff instead of sleeping-in staff have not yet been finalised and for several months the home has used agency staff at night. Wherever possible the home insists on regular agency staff who know the home and residents well. The permanent staff have received training on the administration of emergency medication, but this training has not been provided to the agency staff. The residents have complex needs and depend on staff who are trained, experienced and have a clear understanding of the agreed methods of supporting the residents. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 17 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 While the management of the home was satisfactory for the short-term, it is the permanent appointment of a manager must be given priority in order to create stability and help them to look to the future and long term goals. EVIDENCE: The registered manager, Kevin Brooks, resigned in May 2005 and the deputy manager, Hugh Akiba-Jones is temporarily managing the home pending the appointment of a permanent manager. No notification was made to the Commission of the resignation of the manager – this is required. While High Akiba Jones is acting as temporary manager this has created a staff vacancy within the tem that is being covered by agency staff (see Staffing section). The atmosphere was open, relaxed and happy. Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 18 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 x 3 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 1 1 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Forton House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 2 x x x x x D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 19 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 YA34 Regulation 19 sch 2 Requirement No staff, including agecncy staff, should work at the home until required vetting checks have been carried out and associated documents must be available for inspection at all times. A recent photograph of each member of staff must be available. (The staff records were not checked on this unannounced inspection - these will be checked at the next inspection) The registered person must ensure that at all times suitably qualified and experienced staff are workin in the care home. (This relates to the practice of employing agency staff to cover night shifts. These staff have not received training on the administration of emergency medication and therefore the residents may be at risk) The registered provider must appoint a manager as a matter of priority. Timescale for action 1.9.04 2. YA33 18 1.11.05 3. YA37 8 1.11.05 Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 20 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. Refer to Standard YA6 YA7 Good Practice Recommendations Further work should be catrried out on the care plans in order to ensure that staff have clear and concise instructions on all areas of care. The home should approach local advocacy groups to request support or participation in local peer groups. (This was not dicussed at this inspection, and therefore will be covered at the next inspection) It is recommended that the cost of holidays is included in the contract price. (This was not discussed at this inspection and will be covered at the next inspection) 3. 4. YA14 Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road Exeter, EX4 3AY 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 Forton House D54-D06 21938 Forton House 227581 210705 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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