Inspection on 08/02/06 for Four Nevill Park

This inspection was carried out on 8th February 2006.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Four Nevill Park 30/09/09

Four Nevill Park 09/07/08

Four Nevill Park 31/05/07

Four Nevill Park 29/08/06

Four Nevill Park 29/09/05

Four Nevill Park 04/01/05

Four Nevill Park 13/05/04

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Southfields

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

CARE HOME ADULTS 18-65 Four Nevill Park 4 Nevill Park Tunbridge Wells Kent TN4 8NW Lead Inspector Maria Tucker Announced Inspection 8th February 2006 09:30 Four Nevill Park DS0000023940.V272858.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 Four Nevill Park DS0000023940.V272858.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. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Four Nevill Park Address 4 Nevill Park Tunbridge Wells Kent TN4 8NW 01892 519520 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) Opus Living Vacant Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: Four Nevill Park is a large detached Victorian property standing in its own grounds situated in a private road in an elevated position. It is registered for 24 service users and has been developed to offer care for people with a diagnosis of Autism or Aspergers Syndrome. It offers sixteen single rooms in the main house and six single and one double independent flat. The flats offers accommodation for those service users who require the minimum of support and are staffed independently of the main home. The home is located on the outskirts of Tunbridge Wells; the town centre is a short distance away with easy access to public transport. Shops, pubs, post office and church are within easy walking distance of the home. There are large gardens, mainly laid to lawn, to the front and rear of the home that can be used by service users. There is car parking to the rear of the building. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an announced inspection conducted on 8th February 2006 from 09.35 am to 16.20 pm. It was the second inspection for the year April 2005 to April 2006. The home is under new ownership as from July 1st 2005. The manager took up her post in September 2005. The last inspection was a basic inspection targeted at areas that were considered to pose a risk and to begin to raise the standard of care so that it provides a good quality of life for the service users. This inspection focused on following up from the last inspection and ensuring all the key standards were inspected. It is acknowledged that the service was failing prior to the new ownership and that it takes time to implement the changes required. Substantial improvements have already been made. It has been agreed that as the last inspection contained comments made in comment cards received from the announced inspection that was rescheduled due to the timing of the new ownership only the pre-inspection questionnaire will be required. Received by the CSCI on 23rd January 2006. Some judgements about quality of life and choices were taken from direct conversation with service users individually and collectively, as well as direct observation followed by discussion with staff. Information was gained through conducting a case tracking exercise and document reading. Discussions were held with the Manager, area manager and staff. A partial tour of the premises was undertaken. It is recommended that this report be read in conjunction with the last inspection report to enable the reader to gain a full picture of the home, as some of the standards that were inspected and met during the last inspection were not inspected during this inspection. What the service does well: The home has been though a difficult time with the uncertainties and changes to the service. The staff and manager have worked very hard to minimise this effect on the service users, demonstrating their dedication and commitment. The owners and manager recognise that the service needed to be re evaluated and reviewed so that clear decisions can be made as to what the service is providing, how it is providing this and to whom. This process has begun and plans have been drawn up to improve the internal accommodation and environment. There have been new care plans that continue to be introduced for all service users, these are informative and person centred. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 6 The new manager has a very good level of understanding and insight into the service user group and has a clear sense of direction and vision for the management of the home. 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. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 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 the following standard(s): 1, 2 Prospective service users have written information to assist them and their carers/representatives to choose if the home is suitable for them. EVIDENCE: A revised version of the statement of purpose was received by the CSCI. This document contained all items required. The service users guide is still being worked upon and will be in widget for those service users who require pictorial formats. There have been no new service users admitted since the last inspection. There is an assessment format that has been devised. The manager discussed how the process of admitting news service users would be devised on an individual basis with information gathering to provide an accurate picture of the prospective service user and their particular needs. The service user admitted prior to the manager taking up post, who was identified in the last inspection as not adequately assessed or having their needs met has moved from the home. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 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 the following standard(s): 6, 9 standard 7 was met during the last inspection. With the implementation of the new care planning systems service users continue to have more choice, flexibility and involvement. Risks posed to service users are assessed but need to be integrated into the care planning systems formally. EVIDENCE: The home introduced new formats for care planning systems, based on the essential life planning, taking a ‘client centred approach’ in a service user life plan. The ones that have been completed and viewed during the last inspection were very comprehensive and informative. One care plan inspected and discussed did need to have more details added in relation to medication and a more comprehensive risk assessment format conducted and incorporated into the care plan. Two service users are supported on a one to one basis. Staff had a good understanding of the possible risks with activities especially with those service users whose behaviour can be unpredictable. Staff assess activities prior to supporting service users and continually monitor the situation to take preventative action to minimise risks. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 10 Service users undertake a range of activities, which may pose risks these include outdoor pursuits and daily living independent tasks. It is recommended that staff be provided with ID (identification badges) when supporting service users in the community. New risk assessment formats have been devised. The risk assessments continue to be reviewed and will be updated as part of the introduction of the new care planning formats. Staff spoke of how they were concerned when supporting service users that if they should be injured at work the new changes in contracts would mean they would no longer be paid for sickness. An incident had occurred where a staff member had received an injury and required some time off. It was discussed that the behaviour of some service users does pose a risk that can be minimised but not eradicated. Staff are committed to supporting service users with activities to enhance their quality of life. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 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 the following standard(s): 13, 14, 16, standards 11, 12, 15, 17 were met during the last inspection Service users are individually supported with their leisure and independence life skills. EVIDENCE: Service users have individual daily activities. One service user spoke of how they enjoyed shopping trips and went by bus independently. During the inspection service users were coming and going being escorted dropped and picked up from various day services. Staff spoken with felt that there would not be enough staff around to support service users with planned events should an unplanned situation arise. Extra staffing was bought in to cover a planned swimming trip. There are planned activities in the home for leisure and recreation although most service users are supported with community based pursuits. These include rock climbing, pubs, cinema and the theatre. Service users are supported with life skills such as cooking, household chores and daily living tasks to promote and maximise their independence. The level of support is individually tailored and varies from minimal prompting and Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 12 emotional support to one to one staff. Service users spoke about their daily routines and what and when they preferred to do things. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 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 the following standard(s): 18, 19, 20 The medication policy and procedures in the home are not robust or adequate to ensure service users needs are safely met. Service users general health and specialist support needs are met via external agencies. EVIDENCE: The staffing arrangements have been reviewed and changed so that one staff team provides support to all service users. The home operates a key worker system. Service users are supported with their medical and health needs. Regular and routine appointments i.e. for dentists and opticians take place. Specialist services such as the community learning disability team provide a range of individual support i.e. speech and language therapy and behaviour management guidance. Advocacy services are used when required. Family and appropriate others i.e. care managers act as advocates for some service users. The medication storage facilities are not adequate. The medication room was cluttered, dirty and generally not fit for purpose. The staff could not locate the Royal pharmaceutical society guidelines or BNF. Information on the side effects for medication was not available for all medication and information Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 14 relating to a service user who was no longer in the home still kept with current information. The procedure of re potting medication to dispense must be reviewed. The case tracking for a service user who self medicated found that the risk assessment was not adequate in that it was not transposed into actions in the care plan and there was no evidence of training or special support. Ointments were not kept separate. A medication label was defaced. There was no overall monitoring of the medication policy and procedures or any system in place such as an incident book or the mar charts checked for accuracy, to allow for lessons to be learnt or practice improved upon. One service users medication was placed in the sink having not fully been administered. The guidelines for when and what amount i.e. 1 or 2 tablets to administer on a PRN basis was not clear. Rectal suppositories were prescribed although they had not been used for some time. It was not clear or recorded of any staff having received training to administer these if required. In house training was provided to staff. From the evidence found during this inspection the training offered has not proved adequate or effective for the safe handling and administration of medication. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Service users can continue to feel confident that they will be protected through the prompt and responsive action taken by staff. EVIDENCE: The pre inspection questionnaire states 8 complaints have been made, 5 were substantiated, and 3 were partially substantiated. All were responded to within 28 days. There has been 1 adult protection alert raised. This was managed promptly and appropriately by the manager and staff. Evidencing good practice and a pro-active approach in supporting any issues that may cause concern or be raised as adult protection alerts. The home continue to act as appointee for some of the service users. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 16 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, 25, 30 Overall the service users home is pleasant and homely. EVIDENCE: The pre inspection questionnaire lists the maintenance and associated records. These were spot checked during the inspection. Many improvements have already been made such as better lighting installed; some of the grounds cleared; rearranging of the use of some rooms such as the office moved to create a large space for service users communal use. Plans for internal improvements were seen and discussed during the inspection these developments will improve the standard of accommodation and use of the environment. It is recognised that proposals for changes to the environment are in the planning and discussion stage. The room used for the storage of medication needs to be reviewed as fit for purpose as identified earlier in the report. During the inspection new sofas were being delivered and the handy person was putting up new pictures decorating the hallway. The home was generally well maintained and cleaned. The kitchen does require to be refurbished as identified as part of the homes improvements. The radiators that have not been covered need to have covers fitted. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 17 A service user who invited the inspector to view their flat was proud to discuss how nice it was and how they were supported to keep it clean and well kept. Commenting “I rather enjoy it here”. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 18 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, 33, 34, 35, 36 Systems are in place to ensure that staff receive training and support. EVIDENCE: The pre inspection questionnaire states that 1 service user exhibits extreme behaviour; 8 service users require support with bathing; 3 service users require two or more staff and 3 service users who have specialist communication needs. The staff rota listed staff on duty and identified roles and responsibilities. The staffing levels are 5 or 6 care staff including a senior staff. The manager is supernumerary and the deputy manager has 2 days a week non-direct care. There is extra staff provided for maintenance, cooking and cleaning. The staffing rota has been devised so that planned training can take place. Staff spoken with confirmed that they had received training since the last inspection and had training booked. A training matrix has been developed to identify short falls and gaps in training needs. The home continues to work towards 50 of care staff trained to NVQ level 2 or above. As highlighted earlier the training for staff for medication needs to be reviewed. From discussions and observations made staff have a good understanding into the specialist needs of this service user group. Training for essential life planning has taken place. Other training included fire training; manual handling; fire safety; adult protection; first aid; health and safety. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 19 A new staff file inspected was complete and evidenced that robust policies and procedures are now in place and followed. It was advised that the application form would benefit from being amended to provide space for comments to be made on any gaps in employment. Staff spoken with confirmed that they were receiving regular supervision and had an appraisal. Supervision notes were seen but not read. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 20 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): 37, 38, 39, 42 The service continues to be developed. Service users benefit from having a dedicated staff team and competent manager. EVIDENCE: The pre inspection questionnaire states the manager has overall responsibility for the home. The assistant manager has responsibility for training and review care plan. Senior staff are responsible for shift plans, medication allocation of activities and staff, personal allowance. The staff moral was low and staff sought out the inspector to discuss their concerns in relation to the new changes in working conditions and difficulties they were experiencing with pay and resolving issues outside of the home. A staff has made a grievance to the new providers. Staff expressed how positive the changes were that have been put in place by the new manager stating, “There has been a lot of positive changes”. Staff spoken with felt the manager was supportive and resolved issues within her control as they arose. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 21 The manager has been registered with the CSCI. From the inspections conducted and the fit persons process the manager has demonstrated her competence and good management skills in turning the service round, working with others and improving the quality of service for the service users. The home is developing its quality assurance systems to collate information and work as far as it is reasonably practicable to do so with service users in the proposed changes and developments. Service users meeting are held. It is recognised that as the home is under new ownership quality assurance is in the early stages. The pre inspection questionnaire lists the maintenance and associated records these were spot checked during the inspection. Records were seen to be kept. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 22 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 2 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 2 3 X X 3 X Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 23 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 YA1 Regulation 5 (1) (2) Requirement Timescale for action 22/03/06 2 YA20 13 (2) 3 YA35YA32 18 (1) (a) The registered person shall produce a written guide to the care home (in these regulations referred to as the service users guide. The registered person shall supply a copy of the service users guide to the commission and each service user. The registered person shall make 22/03/06 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The registered person shall 22/03/06 ensure that at all times suitably qualified persons are working in the care home in that 50 of care staff are trained to NVQ level 2 or above and mandatory training is provided to all staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 24 No. 1 2 3 4 Refer to Standard YA6 YA9 YA9 YA23 Good Practice Recommendations It is recommended that the new care planning formats continue to be introduced for all service users. That risk assessments are transposed into the care plan. It is recommended that as the care plans are updated the risk assessment formats continue to be updated and reviewed. It is very strongly recommended that staff be provided with ID (identification badges) when supporting service users in the community. It is very strongly recommended that the home seek possible alternatives for appointees for service users who have the staff of the home act as their appointee for their finances It is strongly recommended that the home continue with the improvements to the environment. It is recommended that the application form would benefit from being amended to provide space for comments to be made on any gaps in employment It is very strongly recommended that the lines of how and who to contact and the response by the organisation outside of the home for staff concerns is made transparent and a positive pro active approach taken by the organisation. 5 6 7 YA24 YA42 YA38 Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Four Nevill Park DS0000023940.V272858.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!