Inspection on 09/10/07 for Homelands

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 19/04/06

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 S Gawley Unannounced Inspection 09th October 2007 09:00 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.V347604.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 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.V347604.R01.S.doc Version 5.2 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 01243 828122 Mr Tony Robert Puttick ** Post Vacant *** 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.V347604.R01.S.doc Version 5.2 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) 16th June 2006 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. The registered managers post is vacant. The fees charged are £400-£478. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit as part of the inspection process took place on the morning and afternoon of 09 10 07. The acting manager facilitated the inspection. The commission was in receipt of an Annual Quality Assurance Assessment (AQAA) but not all documents required on the day were available. Three residents were case tracked, their care plans and medicine administration charts were inspected and they were also spoken to, only one was able to offer an opinion on the home and he expressed satisfaction with the care and also with the food. Two other residents spoken to on the day stated satisfaction with the care they receive and that they enjoyed the activities. Two relatives were spoken to on the telephone and they expressed satisfaction with the home. They stated that the staff were communicative. All comments were positive. A Social Worker was spoken to on the telephone and she stated that Social and Caring Services feel there has been an improvement in the home of late and that they would place people there. A District Nurse was spoken to on the telephone to and she stated that carers can follow instructions. The home she said is also good at notifying the District Nurses if there are changes in pressure areas. Staff were observed offering care in a respectful and encouraging manner. The atmosphere in the home was very relaxed and sociable. The majority of the residents were sitting in the sitting room. This report is compiled using information as described above and also information held on file at the Commission. The adult protection issue mentioned in the last report was investigated, concluded and the staff member referred To the Protection of Vulnerable Adults List. The standards inspected on this visit were judged as good or adequate. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The acting manager needs to register with the Commission and has been advised to set this process in motion. Care plans could be more comprehensive and the quality of recording improved. This will be a recommendation of this inspection. Staff do not currently receive supervision. Induction and the training schedule are not up to date. These will be requirements of this inspection. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 8 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.V347604.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate because resident’s needs are not fully assessed prior to admission. This judgement has been made using available evidence including a visit to this service. Standard 6 does not apply. EVIDENCE: Three residents were case tracked. They did not have evidence of preadmission assessment. These residents were admitted some years ago. The acting manager stated that she now assesses all residents prior to admission either in hospital or home. There is documentation in place to support this but it is basic and provides scant information. The need for each area to be addressed more comprehensively was discussed. A statement of purpose and a Service User’s Guide is made available to the prospective residents and relatives. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 10 Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate outcomes because needs are assessed and met and residents are treated with respect. Care plans could be more detailed. This judgement has been made using available evidence including a visit to this service. 7-10 Residents have a plan of care documented, which could be more comprehensive. The resident’s health care needs are met. Medication is safely stored and administered in the home. Resident’s privacy and dignity is respected and protected by the staff. EVIDENCE: All residents had a plan of care. Three residents were case tracked. The care plans inspected contained information on health, personal and social need. Skin is assessed and residents are weighed monthly. Other than the original diagnosis there is not any ongoing reference to mental health and therapeutic interventions. The acting manager stated that she and a senior carer are completing a course on dementia and she hopes to develop skills in Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 12 this area. She stated that the General Practitioner is consulted as necessary and the Community Psychiatric Nurse was consulted last week. Evidence of this was seen in the care plans. There was evidence that the District Nurse is consulted appropriately. The district nurse was spoken to and she stated that carers can follow instructions. She has recently been instructing carers in the management of diabetes and the administration of insulin and they have taken this on well. The home she said is also good at notifying the District Nurses if there are changes in pressure areas. The quality of the recording of information was variable and the care plans did not consistently reflect the care being delivered. Medicines are stored, administered, recorded and disposed of appropriately. There are not any residents who administer their own medicine. Medicine administration charts inspected were up to date. Carers were observed offering care in a respectful manner. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The lifestyle offered in the home meets resident’s needs and preferences. Visitors are welcome and residents enjoy a varied diet. People who use this service experience good outcomes as activities and events provided satisfy their social, cultural and recreational needs. Nutritional food is offered of a good quality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an activities programme, which offers a musical activity for one and a half hours four afternoons a week. Residents spoken to stated that they enjoyed the music. Responses on a survey sent by the home to relatives expressed satisfaction with the activities. Residents are taken for walks weather and ability permitting and there are seasonal events planned such as a choir, a Christmas party and a pom-pom troupe. Staff were observed interacting appropriately with residents. Relatives spoken to on the telephone stated that they are made welcome when they visit. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 14 Residents’ have choice over aspects of their daily lives such as bedtime and rising time. Residents are encouraged to take meals in the dining room but may have them in their rooms if they wish. There is choice in meals and residents were observed being asked which choice the wished on the day. There is a four-week menu in place and residents are offered a nutritious choice of food. The cook was being assessed for her National Vocational Qualification 3 during the visit. There was ample freezer, fresh and dry food stores. Residents requiring assistance were mostly offered it appropriately with one carer sitting with some residents. However one other carer was observed standing to feed a resident in bed. This practice was discussed with the acting manager. The meal served on the day appeared nutritious and well presented however, the residents requiring a soft diet had the components of the main course all pureed together which did not appear appetising. Neither did these residents have a tablecloth on their table as did the other residents tables. These practices were discussed with the acting manager who stated that she will amend these. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate outcomes because there is a complaints procedure but not all staff have received safeguarding adult training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place and relatives spoken to state that if they had a problem it would be dealt with. There was no complaints book in place and the acting manager stated that complaints would be jotted on her notebook and that the home had not had any recent complaints. The need to have a means to record any complaints formally was discussed with the acting manager and she stated that she would do so. The adult protection issue mentioned in the last report was investigated, concluded and the staff member referred To the Protection of Vulnerable Adults List. The last safeguarding adult training for carers was in September 05. A new member of staff of three months has not had this training as yet. The need to put in place safeguarding adults training was discussed with the acting manager. This will be a requirement of this inspection. She herself is due to attend the safeguarding adults road show, run by West Sussex County Council next month. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 16 Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience good outcomes because residents live in a comfortable and safe environment. This judgement has been made using available evidence including a visit to this service. 19,20,21,26 Residents live in a safe and well-maintained environment and have comfortable communal facilities. Residents have comfortable personalised bedrooms. The home is clean and hygienic. EVIDENCE: The premises were toured. There is a comfortable and well-furnished sitting and dining room. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, safe, comfortable and reasonably well maintained with some areas of paintwork needing to be redone. There are toilet facilities close to the communal areas. There are two assisted bathrooms downstairs; the hoist does not work in one. The acting Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 18 manager stated that the home has been offered a grant to refurbish the bathrooms. The proprietor was spoken to on the telephone and he stated that this work will commence very soon. A larger refurbishment plan including the provision of some ensuite facilities is at the planning stage and is expected to commence in January 2008. Bedrooms are spacious and are personalised. There are three shared rooms and these have ensuite facilities. The home on this occasion was neat, clean and free from offensive odours. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate outcomes because the recruitment process is good but a lack of training may mean that residents are not always protected. This judgement has been made using available evidence including a visit to this service. 27-30 Residents are protected by the homes recruitment policies and procedures but not by an induction and training programme. EVIDENCE: Relatives spoken to stated that they are happy with the care offered by staff in the home. Staff rotas show adequate numbers of staff on duty, two carers and the acting manager by day, two carers in the evening and one waking and one sleeping at night. There is appropriate ancillary staff. Staff were observed appropriately caring, moving and interacting with residents but a lack of training may mean that residents are not always protected. Staff files inspected showed evidence of Criminal Records Bureau Clearance, a POVA check and contained all the documentation required in Schedule 2 of the National Minimum Standards. There has not however, been the provision of mandatory training and neither is there an induction process. The acting manager recognises the importance of training and the need to put these in place was discussed with her. This will be a requirement of this inspection. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 20 Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate outcomes because there is not experienced management yet in place. This judgement has been made using available evidence including a visit to this service. 31,33,35, 36, 38 Residents and staff do not benefit from experienced management. The home is run in the best interests of residents. Staff are not currently supervised. Quality assurance procedures are in place and are being further developed. EVIDENCE: The registered manager resigned in May and since that time the deputy has taken on the management of the home. She is still somewhat inexperienced in the administration of the home. She has commenced the RMA and is doing a course on dementia. She has yet to apply to The Commission for registration. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 22 The proprietor was spoken to on the telephone to give him feedback following the inspection and he stated that the acting manager would be supported to develop in her role. From speaking to relatives, a Social Worker and a District Nurse it is evident that the home is run in the best interests of the residents. The home does not handle any monies for residents. Staff are not currently supervised. The acting manager is aware that this needs to be put in place and she is having training on the 17th October to enable her to fulfil this function. The training will cover supervision and appraisal. The home has completed and returned to the Commission an AQAA. Relatives have recently been surveyed by post. This may be extended to health and social care professionals in the future. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 23 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X 3 3 3 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 24 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 OP18 Regulation 13(6) Requirement Timescale for action 21/12/07 2 OP30 18 (1)© 3 OP38 38 The registered person to make arrangements for training to prevent service users being harmed, suffering abuse or being placed at risk of harm or abuse. The registered person to ensure 21/12/07 there is a staff training and development programme including induction and all mandatory training. The registered manager ensures 21/12/07 so far as is reasonably practicable the health, safety and welfare of service users and staff. 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 OP7 Good Practice Recommendations Care Plans to set out in detail all actions taken by staff to meet resident’s needs. Training in record keeping may support this. DS0000014577.V347604.R01.S.doc Version 5.2 Page 25 Homelands 2 OP36 Supervision to be put in place for all staff. Homelands DS0000014577.V347604.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Homelands DS0000014577.V347604.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. 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!