Inspection on 09/07/08 for Four Nevill Park

This inspection was carried out on 9th July 2008.

CSCI found this care home to be providing an Good service.

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

Four Nevill Park 30/09/09

Four Nevill Park 31/05/07

Four Nevill Park 29/08/06

Four Nevill Park 08/02/06

Four Nevill Park 29/09/05

Four Nevill Park 04/01/05

Four Nevill Park 13/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Four Nevill Park 4 Nevill Park Tunbridge Wells Kent TN4 8NW Lead Inspector Gary Bartlett Unannounced Inspection 9th July 2008 09:00 Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 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.V367458.R01.S.doc Version 5.2 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.V367458.R01.S.doc Version 5.2 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) springmeadow@ilg.co.uk Evesleigh (Kent) Ltd Vacant Care Home 24 Category(ies) of Learning disability (0) registration, with number of places Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 24 31st May 2007 Date of last inspection 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. The home has been developed to offer care for people with a diagnosis of Autism or Aspergers Syndrome. It 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. Although it is registered for 24 service users it is used to accommodate 20 people. It is set out over four floors and is divided into three units. There is also accommodation for people in semi-independent flats and these are located around the building. The home employs support workers, operating a roster, which gives 24-hour cover. The home has an administrator, a person is employed to help with cleaning and there is a maintenance person. The current fees range from approximately £850 to £1,600 per week. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Four Neville Park on 9th July 2008 from 9:00 am until 2:00 pm. During that time the Inspector spoke with some residents and some staff. Parts of the home and some records were inspected and care practices observed. Prior to this inspection an Annual Service Review was conducted in May 2008 and ten people living in the home, two Care Manager and some staff returned survey forms. Feedback indicated differing views of the quality of service. At that time, the current Manager had only just taken post. Since then, as detailed in this report, he has made positive moves to improve the service where necessary. The Inspector would like to thank everyone for their contribution to the inspection. What the service does well: There is an open and friendly atmosphere in the home, which is run in the interests of people who live there. The care is person-centred and individuals’ needs and wishes are met as far as is practicable. Staff working at the home have positive relationships with residents and work hard to improve their quality of life. Four Neville Park offers a homely and comfortable place in which to live. Residents privacy is promoted. Staff are friendly and polite. There are opportunities to socialise, enjoy hobbies and learn more skills. Residents present as being comfortable with staff indicating they feel safe and secure with them. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 8 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.V367458.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is up to date information about the home. Prospective service users’ aspirations and needs are assessed before admission to the home. EVIDENCE: The Manager described how prospective service users are only admitted to the home after a full assessment of needs. These are inclusive of relatives and health care professionals and are the starting point for service users’ individual support plans. The records sampled included assessments of personal support, health care needs, religious and cultural needs and social activities. The Manager confirmed the home offers service users a ‘settling in’ period to ensure the home is the right place for them and they are compatible with people already living at the home. An up to date Statement of Purpose is available. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 10 Each service users has been provided with a statement of terms and conditions about what they can expect in terms of their rights and responsibilities relating to the care provided. The service agreement is easy to read and since the last inspection has been made more detailed. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improved systems to identify service user’ needs and how they are to be met are being introduced. Service users are enabled to make decisions about their lives, as far as is practicable, with assistance given as needed. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: Each service user has a care plan. Three were inspected in detail. The Manager is in the process of introducing a new care plan format that is more person centred, with information better presented and more readily accessible. Each service user now has an individual health record. Their relatives were involved in writing these and they include medical histories and details of Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 12 current medication. The records are used to inform staff and can be taken to doctor or hospital appointments for the effective sharing of information. The Manager is aware that some daily records of care need to be more carefully written to accurately reflect service users’ current welfare and the care given. Accordingly, the records are being monitored and guidance given where required. Through discussion with the staff, reading the care plans and observation, it is evident that service users are given full support and encouragement to receive good standards of health and social care. Risk assessments are being written/reviewed in response to incidents and accidents. The home does not act as appointee for service users’ monies. There are sound systems for holding service users’ monies and recording cash held and payments made. The Manager said the monthly visits done by the company audit the handling of service users’ finances. Interaction between service users and staff was observed to be good showing genuine respect, friendship and appropriate familiarity with each other. Records seen are kept in a manner that maintains confidentiality and there are facilities for them to be stored securely when not in use. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy individual lifestyles and are supported to develop their life skills. They have the opportunity to experience a variety of social, educational and recreational activities. EVIDENCE: From observation, discussion and records it is clear that service users benefit from improving opportunities for personal, emotional and social development and are supported towards independent living skills, tailored to their abilities. Service users are treated as individuals and are consulted about their different interests and aspirations, which they record in their personal plans. Activities Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 14 are provided accordingly. The range of opportunities available to service users is being broadened. Service users spoken with clearly enjoyed the activities that they are involved in. Service users spend time in the home relaxing, watching television listening to music or undertaking activities that interest them. They also receive guidance with the development of skills within the home with the support of staff. Service users are encouraged with shopping, cooking, cleaning, laundry and household tasks. If they wish, service users can enjoy privacy in their rooms and staff respect this. Staff talk with service users in a friendly and polite way. Service users are part of the local community. During weekdays some may attend college, participate in social events and activities that personally interest them or further develop their life skills. Service users are able to see their family and friends as often as they wish. Individuals can visit the home at any reasonable time. Service users are supported in planning holidays and have had the opportunity to go on a trip of their choice. Service users participate in planning the menus and those seen show they enjoy a balanced and nutritious diet with a variety and choice. With support, service users are involved in the preparation and cooking of foods to the best of their ability. Several service users said they enjoy the food at the home. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from personal support which meets their individual needs. Their privacy and dignity is respected. EVIDENCE: The improved care plans being introduced will show that staff are made aware as to the type and nature of the support required for individual’s personal and intimate care needs. Staff spoken with have a good understanding of the preferred routines and varying requirements of each service user. Through discussion with the staff and assessing the three care plans, it is evident that service users have ready access to health and social care professionals and are supported with any specialist appointments and/or interventions. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 16 The Manager said staff provide flexible support to service users based on individual choice and personal care is provided in private to promote their dignity. Observations confirmed service users had good personal hygiene and were appropriately dressed for their activities. Guidance regarding personal hygiene is recorded in individual care plans. A procedure is in place for the administration of medication by the home, which aims to protect service users. Records show that all staff administering medications have been trained and signed off as being competent to do so. All staff have had further instruction in the management of medication and the home’s processes have been made more robust. Most Medication Record Administration Record (MAR) sheets are computer generated by the pharmacist but some are hand written. One had not been signed by the person completing it and countersigned by a second person confirming its accuracy. The Manager undertook to address this immediately to lessen the potential risk to service users. The facilities for the storage of medicines on Ruby and Amber should be reviewed. Whilst clean and well maintained, they are cramped without hand washing facilities and have limited ventilation. The latter makes it difficult to always store medicines at the recommended temperature. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ views and concerns are listened to and receive appropriate consideration. There are systems to protect service users are protected from abuse. EVIDENCE: The home has a clear, up to date complaint procedure that is readily available. The procedure is also available in a pictorial format for service users. Records are kept of complaints, their investigations and outcomes. The Manager described how these are used to inform future practice. There are procedures for protecting service users from abuse and staff are required to attend training in this. Staff spoken with have a good understanding of the protocols to safeguard adults. There have been 2 Safeguarding Adults alerts in the last 12 months, one of which is ongoing. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, comfortable and homely environment. EVIDENCE: The home is situated in a quiet private road just outside the centre of Tunbridge Wells. It stands in its own gardens with private car parking space. The property is set out over four floors and has been arranged into three units, Amber, Emerald and Ruby. Alongside these units there are a number of semiindependent flats. The home has undergone substantial refurbishment and there are plans for further improvement. All the communal areas on the different floors are decorated in a homely and comfortable and people living in the home said they like their own personal Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 19 space and the bedrooms seen are personalised with service users’ possessions and choice of furnishings. It was observed that some of the sash windows are difficult for service users to operate and have to be wedged open. Although there have not been any accidents recorded in connection with these windows, they may place service users at risk and should be repaired or replaced. Staff and service users are responsible for keeping the home clean with the assistance of a cleaner who works 15 hours per work split between two days. The parts of the home seen were clean and free from unpleasant odours. Infection control is generally well maintained, although it was noted the laundry on the ground floor is not equipped with a hand-wash basin, people using a nearby bathroom for this. The home benefits from a very competent maintenance person who operates good systems for monitoring health and safety in the home. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Four Neville Park has a committed staff team. Training is being made available so they have the skills to meet service users’ needs. Robust recruitment processes ensure only appropriate people work there. EVIDENCE: From observation and discussion, it is clear the staff are very focussed on the needs of the people living in the home and work closely with them. Service users like the staff and find them approachable, polite and kind. Throughout the site visit there was evidence of good relationships between staff and service users. Staff mentioned how much they enjoy working with the service users and this is reflected in the way care and support is given. Staff obviously know the service users well and how best to put them at ease. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 21 The home is divided into three units, each with an allocated a staff group. Occasionally there is some movement of staff between units/floors to cover sickness or annual leave, but it is intended the staff groups remain stable to provide continuity of care to individuals. There is a full staff handover with seniors from each unit taking part so they can be aware of any particular needs that they should be aware of. This ensures the different areas of the home do not become isolated from each other. Staffing levels on each unit reflect the dependency levels of the service users living there. Staff ratios have been increased to an appropriate level and additional staff are being employed. Five staff have been appointed and will commence duties when the appropriate checks have been received. When they start, the home will be less reliant on bank staff and more able to provide stimulating activities. Since he has taken post, the Manager has also introduced a new staffing structure to giving improved support and accountability. This includes the appointment of a third Deputy Manager and a part-time Administrator. People applying to work at the home have to complete an application form, provide two references and have a POVA and Criminal Records Bureau (CRB) check and attend an interview. The files of the most recently recruited staff show that appropriate checks are made prior to them commencing duties. There is an induction programme in place for new staff and this is in line with Skills for Care. The Manager is requiring all current staff to complete the inhouse induction programme to ensure basic competencies. Records indicate more training is being made available to staff. One staff member said “A lot more training is happening now”. Staff meetings are held regularly and the Manager uses the meetings to make sure that staff are fully up to date with different polices, procedures and current good practice. Some staff spoke of irregular supervision. The Manager stated he is aware of this and is going to implement a programme of supervision that will be delivered by himself and the three Deputy Managers in the immediate future. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home benefits from a manager who is experienced, qualified and has a high expectation of the standard of service to be given. EVIDENCE: The Manager has been in post since May 2008. It is clear that in that short time he has implemented many changes to improve the quality of life for service users. He said the owners, Evesleigh (Kent) Ltd, have been very supportive in enabling him to do this. The Manager has extensive experience of working with people with a learning disability and has acquired the Registered Managers Award and NVQ level 4 in health and social care. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 23 Application for his registration as Manager will be made in the near future. The Manager demonstrates a commendable commitment to delivering a high quality service. There is a sound system of holding and recording service users’ cash, which is regularly checked as part of an audit process. The standard of cleanliness in the kitchens and surrounding areas is satisfactory and staff are careful to ensure COSHH requirements are met to safeguard service users. There are very good systems for the regular checking of fire safety systems. Evesleigh (Kent) Ltd is intending to employ a new team to undertake the monthly Regulation 26 visits. There are regular service user meetings and their families and friends are sent surveys at 6 monthly intervals. There is a service user audit done each month. Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 X 4 3 5 3 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 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 X Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 25 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. Refer to Standard YA20 Good Practice Recommendations It is recommended the facilities for the storage of medicines on Amber and Ruby should be improved. Currently they are cramped without hand washing facilities and have limited ventilation. It is strongly recommended the sash windows which are difficult for service users to operate and have to be wedged open are repaired or replaced. It is recommended hand wash facilities should be sited in the laundry to better promote infection control. 2. 3. YA24 YA30 Four Nevill Park DS0000023940.V367458.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V367458.R01.S.doc Version 5.2 Page 27 - 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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