CARE HOME ADULTS 18-65
Four Seasons 104 Melbourne Avenue Dover Kent CT16 2JH Lead Inspector
Julie Sumner Announced Inspection 4th January 2006 10:00 Four Seasons DS0000023202.V265156.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 Seasons DS0000023202.V265156.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 Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Four Seasons Address 104 Melbourne Avenue Dover Kent CT16 2JH 01304 226434 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) Mr Gary Thompson Mr Gary Thompson Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 3 People with learning disabilities between 18 and 65 years Date of last inspection 17th June 2005 Brief Description of the Service: Four Seasons provides care and support to three service users with a learning disability. The home has three service users bedrooms accommodated on the first floor. On the ground floor there is a sitting room, dining room and kitchen. There is a spacious rear garden, a front garden and a drive at the side with parking. Local bus services into Dover are nearby. The home is situated on a main bus route to Dover. It is in a good position for service users to access local amenities and is in keeping with the local community. The home also has a vehicle for service users to go out. Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out during part of one day in January, starting at 10am and finishing at 2pm. Two service users were in and participated in the inspection. They both said how much they like living at Four Seasons, “the food is really good”, “they go on holiday”, “they went to Teneriffe this year” and described the holiday with lots of stories of what happened. During the inspection a range of methods were used to gather information including: spending time with the service users including having lunch with them, looking at and discussing policies, individual records for both staff and service users including individual support plans and risk assessments, walking around the home and discussing plans for the building. What the service does well: What has improved since the last inspection?
The home continues to maintain a high standard of support. Service users’ changing social and health needs have been supported effectively. Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 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. Four Seasons DS0000023202.V265156.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 Seasons DS0000023202.V265156.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): 2 All service users have assessments that form the basis of their care and support. EVIDENCE: A sample of service user plans were viewed that include individual assessments of identified needs and interests, which have been reviewed. Four Seasons DS0000023202.V265156.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 Risk assessments are in place to provide a support framework for service users to minimise accidents or distress. These need to be reviewed to make sure that service users’ opportunities to learn new skills are not being limited unnecessarily. EVIDENCE: Service user plans contain up to date information relevant to what service users want to do and how they are supported. Risk assessments to consider potential accidents have been carried out and guidelines are in place for staff to support to minimise them. Service users are supported to carry out daily tasks in the home including some meal preparation and are encouraged to go out independently if able. There was a discussion about periodically testing the risk assessments to see if there were any changes and considering how to teach/support individuals to learn the skills necessary to develop social and opportunities for further independence. Where service users have full support with a task, for staff to stand back a little and reassess with some change of no change depending on response. A recommendation has been made for this.
Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 10 Four Seasons DS0000023202.V265156.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): 12, 16, 17 Service users are supported to find employment if they wish. Service users are able to choose how they spend their time in the home and are supported with their preferred lifestyle. There is a good range of home cooked food provided. Service users would benefit from the opportunity to develop their meal preparation and cleaning skills in the kitchen. EVIDENCE: One service user is currently considering some different employment options having been supported to meet with the specialist employment support officer at the job centre and receiving information on the choice of schemes. One service user has some small pets. Consideration is given to all service users in the home when choosing pets and everyone was happy with the present arrangements. Service users said that if they want to spend some time on their own they go to their room. They do not lock their bedroom doors but could if they wanted
Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 12 to. They have a dining room and sitting room to sit in and there is a spacious garden with seating in the warmer weather. All meals are home cooked. The inspector ate lunch together and talked about the meals provided. Service users said that they eat at different times depending what they are doing and were complimentary about the food they have. They sometimes eat out. Risk assessments are in place regarding service users assisting with meal preparation. Risk assessments need to be reviewed with regard to increasing independence and skills in the kitchen. A recommendation has been made for this. Four Seasons DS0000023202.V265156.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): 19 Service users are supported well with maintaining their health and managing individual health conditions. EVIDENCE: One service user has recently been in hospital for surgery following an ongoing health condition. The service user is being supported the staff and the local district nurse team with aftercare following discharge. Four Seasons DS0000023202.V265156.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): 22, 23 Service users feel protected and are comfortable with voicing concerns to the owner and staff team. They feel that their views are listened to and acted on. EVIDENCE: Service users said they were happy but if they did have any concerns they would speak to the owner or staff. There is a complaints procedure which allows for anonymous or more formal complaints should the need arise. The home has a policy on adult protection and prevention of abuse and a separate whistle blowing procedure. The staff said they have a policy file that they can check. Staff have received adult protection training and have had the opportunity to discuss scenarios as part of the NVQ training. Four Seasons DS0000023202.V265156.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, 26, 30 The home is clean and comfortable providing a pleasant environment for service users and has been furnished and decorated to their taste. EVIDENCE: The inspector toured the home with the owner and then spoke to service users who talked about their interests and pointed out the ornaments, photos and belongings that reflected these. The owner is planning to have an extension. The hall, stairs and landing are showing signs of wear and tear but the building work will come out from that area so refurbishment of these areas will be carried out when the building work has been completed. A recommendation has been made to have a written refurbishment and redecoration plan. The home is clean and there are effective cleaning schedules in place to maintain a high standard of hygiene. The laundry area is set apart from the kitchen with appropriate appliances to suit the needs of service users. Service users do their own laundry with assistance. Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 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 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, 35 Staff are good humoured and have a good rapport with service users. They are supportive to enable service users to have the lifestyle they choose. There are robust recruitment procedures in place to protect service users. EVIDENCE: One member of staff has left employment in the home since the last inspection. A new member of staff has been employed and is due to start in two weeks. The recruitment process included obtaining references and requesting a CRB enhanced disclosure including POVA. One staff has completed the NVQ level 2. Training relevant to the service users is ongoing. Since the last inspection staff have updated fire training and all other statutory training is up to date with some courses needing updating later in the year, although there has been some difficulty with planning these due to courses being oversubscribed. Staff have been trained in specific procedures to support service users health and wellbeing. Staff demonstrated a supportive and positive attitude in their interactions with service users. Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 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 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 Service users and the owner and staff do talk to each other to make sure that what is being provided is what is wanted but this is not written down. Having feedback and plans in writing will form a record for quality assurance and be referred to for home’s development plan. EVIDENCE: The way the owner judges the quality of the service and how this effects the way the home is run and what is provided needs to be more formal so that it can be referred to as part of the home self-assessment. The manager needs to design some written feedback on how the service is meeting service users needs and produce a development plan on the basis of their views. This should incorporate developing individual life skills and experience and any planned improvements to the home and what is being provided. A recommendation has been made for this. Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 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 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x x x 2 x x x x Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 19 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 YA9 Good Practice Recommendations Risk assessments regarding support around life skills need to be reassessed to see if the level of support needed is still the same or whether it is possible to develop independence further. Have a written plan outlining the building work and the refurbishment and redecoration of the home in line with this to include estimated timescales. There needs to be a written annual development plan based on service users views on whether the home is providing what they want and striving for improvement. 2. 3. YA24 YA39 Four Seasons DS0000023202.V265156.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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