Inspection on 19/04/06 for Homelands

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Homelands 14/10/08

Homelands 09/10/07

Homelands 26/09/05

Homelands 27/05/05

Homelands 07/12/04

Homelands 15/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Homelands 21-23 Richmond Avenue Bognor Regis West Sussex PO21 2YE Lead Inspector Mrs H Church Key Unannounced Inspection 08:30 19th and 28th April 2006 X10015.doc Version 1.40 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 Homelands DS0000014577.V289415.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 Older People. 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. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Homelands Address 21-23 Richmond Avenue Bognor Regis West Sussex PO21 2YE 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) 01243 828122 Mr Tony Robert Puttick Mrs Elizabeth Hawkins Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20) Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 20 in the registration category MD(E) (persons with past or present mental disorder - over 65 years) 26th September 2005 Date of last inspection Brief Description of the Service: Homelands is a care home providing personal care and support for up to 20 service users in the category of Dementia and Mental Disorder, excluding learning disabilities - over 65 years of age. The home is situated in a residential area on the outskirts of Bognor Regis, within walking distance of local shops and other community facilities. The accommodation, consisting of 14 single and 3 double bedrooms, all doubles having en-suite facilities, are situated on three floors with all floors having passenger lift access. There is a communal lounge and a dining room which both open out onto a well-maintained rear garden. The Registered Provider is Mr Tony Puttick with a Management Company, Personnel Solutions, over seeing the running of the business. Mrs Elizabeth Hawkins is the Registered Manager of the Home. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place over two separate days. The first visit was to collect pertinent information regarding health care records and staffing information and the second was planned to take part in the morning and over the lunch time period. The manager was present for both visits and ably assisted the inspector with all of her enquiries. The inspector noted that during both site visits, staff were spending quality time with individual residents, either in the lounge or their rooms. A homely, friendly and relaxed atmosphere prevailed and the inspector was made welcome at all times. Although early summer, it was still too cold for residents to be out in the garden to enjoy the sunshine. For the site visit, the inspector examined previous information and the Statement of Purpose and Service Users Guide that informs residents about the service. The manager is reissuing contracts to existing residents and encouraging residents and their relatives to become more involved in the care plans by signing their agreement to these. During the inspection, seven residents and three visitors gave their views to the inspector. Without exception all comments were enthusiastic about the staff and their life there. Two members of care staff said they felt very supported by their manager and her new deputy, carrying out their duties in a relaxed and positive manner. The care plans showed that the care provided is appropriate according to the needs of the residents and the right amount of support to maintain independence and ensure resident’s lives continue to improve was given. There were no requirements or recommendations made at this inspection. Since this inspection took place and before the report was finalised for publishing, the Commission for Social Care Inspection received a serious complaint that has evoked the West Sussex County Council Adult Protection Procedures to be commenced. The results of the investigation into this will be included in the next report. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. All residents had been assessed before moving into the home. The staff at the home are meeting the residents identified needs. Relatives were given enough information to help them decide the home would be suitable EVIDENCE: The Statement of Purpose and Service Users Guide require some updating to include details of the registered manager. Contracts are being redistributed to ensure residents have full access to information relating to the home. Four care plans were examined and showed that residents had been assessed prior to admittance to ensure the home would be able to meet their needs. Risk assessments were in place and care plans to instruct staff how to meet identified needs had been written from the assessments. The visitors told the inspector that they had received good information prior to visiting the home and that extensive information was obtained to ensure all the needs of their relative was taken into account. Social work assessments are obtained for Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 9 residents who are funded but the home still provide an in-depth assessment to ensure care needs are fully met. It was clear from the staff that they were well informed about the care needed and were updating records accordingly. Residents and/or their relatives have signed some care plans as they have been up-dated and the manager told the inspector that this process is continuing for other care plans. Photographs have been included on all care plans. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. All residents had an individual care plan set out for staff to follow. The home operates a policy where all medication is managed by care staff. Care staff are meeting the health care needs of the residents in a respectful manner. EVIDENCE: Four care plans and assessments were examined and seen to include the health, care and social needs of the resident. Risk assessments and nutritional assessments formed part of the care plans. Care plans had been updated and reviewed. Three visitors and the seven residents spoken with, including those case tracked, had only praise for how the staff cared for them and it was clear that they believed their needs were fully met. Evidence of the involvement of the resident or their relative in the assessment and writing of the care plan was seen on some individual care notes. The inspector spoke to a district nurse who was involved in the treatment of residents and had recently completed a quality management questionnaire Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 11 giving very positive views throughout. She confirmed her opinion saying, The home has improved over the last year. This confirmed the view made by the doctor in the last report that stated “A G.P. spoken to on the day of the inspection told the inspector that he had no concerns at all about the care being provided at Homelands.” The home’s medication procedures ensure safe practice for resident’s outcomes with the handling, administration, storage and disposal of medicines. Staff involved in medication procedures have recently attended training and assessed as competent to undertake the procedure. MAR charts were accurate with no gaps noted in recording of administration of medicines. Hand washing instructions were well displayed with instructions for the use of specialist soaps and gloves. All wash hand basins had liquid soap and paper towels to prevent cross infection. The policies and procedures were up-to-date for the referral and treatment of infections. The inspector observed very good care practises, for example one resident became confused and upset over her knitting unravelling and staff responded appropriately and in an understanding and caring way to residents needs and wishes. Policy and procedures are in place to meet the health care needs of the residents and reflect the practises at Homelands but some of these are in the process of being updated by the Management Company employed for this purpose. However, the inspector noted that pertinent policies and procedures were still available for staff to refer to when needed. Staff have received training on residents rights to privacy and dignity and the inspector observed staff knocking on doors and providing quiet areas for visitors. The Visitors Book and the relatives interviewed confirmed that relatives/visitors are encouraged to visit their relative/friend at any time and in private. The manager told the inspectors that arrangements can be made for visitors to join their relatives for a meal and at a separate table so privacy and dignity can be maintained. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Activities are suitable for current residents, visiting is positively encouraged and residents are served meals that are nutritious and appetising. EVIDENCE: Structured activities are provided and one quality management system questionnaire said excellent. Residents were observed participating and enjoying individual activities with staff. On two occasions the inspector observed staff spending quality time with individual residents as well as assistance given to the resident who was upset over her knitting. The activities listed were meaningful and were based on individual residents life styles. All three visitors confirmed that activities are based on their relatives past lifestyles and experiences and are much enjoyed, tending to spark off conversations afterwards. The home’s budgerigar gets involved in all the musical activities and residents are encouraged to be involved in the responsibility of caring for it. The inspector observed that the morning was relaxed and residents ate and received support with personal care throughout this time. Some residents Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 13 were enjoying a late breakfast, coffee and biscuits and chose lunch from a list of alternatives if the main course was not liked. The inspector joined three residents for lunch and from observation, discussion with residents and the relative, the food provided is fulfilling with good choices. The meal provided during the inspection was of a high quality. Two of the visitors told the inspector they had chosen the home from its homely atmosphere and because the menus were suitable for the age of the residents. They said, Mum would enjoy her old favourites and recognise the meal. It’s something she would cook for herself. The inspector spoke with the chef and it could be seen that dishes were prepared according needs and wishes of the residents. Clearly the food was of a consistent high quality and made from fresh ingredients. Home made bread rolls and a birthday cake were cooling in the kitchen. The relatives told the inspector that they have been offered meals, either to eat with other residents or with their relative. The weight charts inspected showed that all aspects of health care and meal planning are linked. Visitors are always made welcome and this was confirmed by the visitor’s book. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents are confident that complaints are taken seriously and acted upon appropriately. Staff have had in-house training in adult protection procedures so are equipped to protect residents from abuse. EVIDENCE: The complaints procedure was displayed in the hall in the Statement of Purpose and Service Users Guide. The complaints log was examined and the inspector observed that the complaint received directly by the Commission for Social Care Inspection had been recorded with all action taken. Two relatives told the inspector that they are continuously consulted about their relative’s care and had no complaints. However, they knew the procedure for complaints and if unhappy with the outcome of the investigation, would speak to their funding authority. Two residents said if they were unhappy with anything, they would tell the staff. Two members of staff confirmed that training included Adult Protection Training and that this had been given in the past year. The manager confirmed that the training programme includes Adult Protection Training and the inspector observed the West Sussex Multi Agency Guideline was present in the office. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The indoor and outdoor areas used by residents are clean, safe and homely with good access to all parts. Resident’s rooms are suitable and homely. EVIDENCE: A tour of the building confirmed that residents are safe and enjoy their personal communal spaces. Appropriate locks are on doors and where staff need to gain access to the equipment cupboards, keys were placed on hooks up high. The communal, garden and individual areas are safe and well arranged to maximise independence without compromising a sense of freedom. The garden area is secure with suitable garden furniture and a large awning. The manager told inspector she wished to encourage any resident wishing to garden. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 16 Continence is well managed with a programme of staff intervention to maintain and improve resident’s sense of well-being and independence. There are plans to remove one of the toilets opening onto the lounge, as this can be embarrassing for smells permeating and change this into a medication room. Toilets are well signed and provided to maximise independence and minimise staff intervention. Two rooms had specialist floor coverings to minimise odours from incontinence. The home employs domestic staff to maintain cleanliness and at the time of the inspection, the home smelt fresh, well ventilated and warm. Some doors did not display the residents name but the manger explained they had been removed when being redecorated. Redecoration and refurbishment is ongoing to meet the collective and individual needs of the residents. The inspector observed new furniture had been purchased and a number of rooms had recently been redecorated. The visitors confirmed that they had been encouraged to bring in any suitable furniture for their relatives needs to ensure she had familiar things around her. Most residents had some age related mobility problems and equipment had been provided to assist residents with this. Some repairs are still outstanding to the heating equipment and the manager told the inspector that the heating system is outdated and needs completely replacing but it is still safe and the hot water and radiators do not exceed safety levels. The inspector observed from the monthly and weekly health and safety checks that window restrictors, equipment and fire procedures are all maintained to ensure residents safety is well maintained. The manager informed the inspector that all the windows are due to be replaced by double-glazing units this financial year. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The duty rota indicated that sufficient staff with a suitable mix of skills and experience are on duty over the 24 hours period to ensure needs can be met. Recruitment processes were in place to ensure residents are protected. EVIDENCE: Staffing levels during the fieldwork were appropriate and ensured residents needs were met. The homes use of agency staff is minimal and agency staff have not been used at all in the past few months. Domestic and catering staff have clearly defined roles. The manager confirmed that recruitment procedures are consistent and reflect the high quality of staff employed. Records are stored in the office with the training records of individual staff. The training programme was adequate and included all mandatory courses at the required intervals. Some periphery courses were provided to meet the needs of residents and the induction programme seemed appropriate to meet the needs of the residents. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 18 Two staff were interviewed and confirmed that training is provided to enable them to meet the needs of residents and that a number of courses were available to them. The staff interviewed had all received some training applicable to their roles and level of expertise. The inspector observed that the Protection of Vulnerable Adults checks have been made prior to employment with Criminal Records Bureau checks completed on all new staff. The staff confirmed that they receive supervision at the required intervals. The inspector noted that a procedure to accompany supervision was not comprehensive but the manager said that following the employment of a personal services firm, these were all being revised. Records showed that four staff are taking National Vocational Qualifications and one had already achieved this. The National Minimum Standards expects that 50 of care staff should have National Vocational Qualifications and the home is still working towards this figure. The training and development policy and procedure, although listed, was not on file. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home is run in the best interests of the residents whose health, safety and welfare is promoted and protected. EVIDENCE: The manager has completed the National Vocational Qualifications level 4 in Care and is completing the Registered Managers Award. The newly appointed deputy is being encouraged to enter into management courses. A formal quality assurance programme has been identified and the inspector observed some responses. All were complimentary and spoke of “improvement. The registered provider has submitted some monthly reports Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 20 of visits to the home and has spoken with residents and their relatives to seek their views on an informal basis. Residents are encouraged to manage their own finances or if this is not viable, a representative of the resident provides this. The homes policy on residents money are that this remains the responsibility of the individual and no monies are held on behalf of residents. Two members of staff confirmed that supervision is provided at the required intervals and that training needs are identified from this procedure. The manager confirmed the procedure and stated that the newly appointed deputy is shortly to be involved in providing this for staff. The inspector tracked two accidents recorded in the care plans and noted that the documents used that meet the Data Protection Act. Currently accidents are transferred onto an auditing system for analysis. The fire safety document was seen to be in place and available for staff to examine at any time. Health and safety is maintained through training and servicing of necessary equipment. A maintenance book showed that it included the date of request, job required, date of completion and signatures to confirm information. Health and safety checks are carried out weekly and monthly and the inspector observed from the information recorded, that all aspects of risk had been assessed. Good moving and handling practise was observed that minimises risks to resident’s health safety and welfare. The inspector did observe that policies and procedures are not coherently filed making it difficult for staff to access quickly. The manager agreed to rectify this. Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard Good Practice Recommendations Homelands DS0000014577.V289415.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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. 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