Inspection on 07/06/05 for Homeleigh

This inspection was carried out on 7th June 2005.

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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Homeleigh 23/07/08

Homeleigh 10/08/07

Homeleigh 30/08/06

Homeleigh 04/10/05

Homeleigh 04/11/04

Homeleigh 24/06/04

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

CARE HOME ADULTS 18-65 Homeleigh Sondes Road Deal Kent CT14 7BW Lead Inspector Joseph Harris Unannounced 7th June 2005 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 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 Stationary 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. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Homeleigh Address Sondes Road, Deal Kent, CT14 7BW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 380040 Homeleigh Care Limited Mr Dhunputh Seewooruttun Registered Care Home 16 Category(ies) of Mental Disorder registration, with number of places Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 04/11/04 Brief Description of the Service: Homeleigh is a residential home for people with enduring mental health problems situated in the seaside town of Deal. The home is registered for up to 16 people between the ages of 18-65. The service is set out over two floors, with a small number of bedrooms on the ground floor and the remainder on the first floor. The home benefits from a good level of communal space with a large lounge and an ample dining room. There is also a designated smoking room. A secure courtyard garden is located to the rear of the building. There are adequate kitchen and laundry facilities. The service has a relatively small, but stable staff team, many of whom have worked in the home for a number of years. The house is located very close to Deal town centre and within view of the sea. There are relatively good public transport links nearby and the town is well equipped with public facilities such as a library, cafes, sport centre, cinema and theatre. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Staff in the home have worked diligently since the last inspection to address a significant number of the previous requirements made. They have been supported in this by the registered providers, who visit the service on a regular basis. A new member of staff has been employed who holds an NVQ level 4 and has been able to address some issues surrounding record keeping and administration. During the course of the inspection a tour of the premises was completed and discussions were held with staff and service user. A variety of records and documentation were also examined including health and safety documents, service user and staff files, policies and procedures and medication records amongst others. What the service does well: What has improved since the last inspection? Significant and positive strides forward have been made over the past 6 months, which have coincided with the appointment of a new senior member of staff. Amongst the areas of improvement are care planning processes and assessment of service users, staff training, staff working conditions, recreational activities for service users and staff recruitment issues. In addition to this staff and residents meeting have been recommenced and staff have more delegated tasks improving the structure of the home. Staff supervision has been commenced and some medication issues have been resolved. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 3 and 5. Prospective service users are provided with adequate information about the home. Sufficient levels of assessment are received from referrers and/or care managers, although an improved assessment tool should be developed by the home. The service can meet the assessed needs of service users. All residents receive a suitable contract covering key terms and conditions. EVIDENCE: The home has redeveloped and reviewed information in the statement of purpose and service users guide. Both of these documents now contain sufficient information in adequate detail. A copy of the service users guide is kept in each bedroom and the statement of purpose is readily available on request. There were 14 service users living in the home at the time of the visit. Many of these people have lived in the home for many years. However a good level of assessment information is received for all newer service users. The home requests background information, care management assessments and Care Programme Approach care plans at the point of referral. There are plans to introduce a new assessment format within the home, however this tool is over complicated and does not adequately cover the salient information required. A discussion was held with senior staff regarding this and it was recommended that this tool should be reviewed to ensure it is appropriate for Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 9 the needs of the home. Refer to recommendation 1. The home has developed reasonably good links with local community mental health and other healthcare resources. There is a relatively experienced staff team and the provision of training has improved although there remain some shortfalls in mandatory training, NVQ and other service specific training such as mental health awareness. Refer to requirement 1. Service users are able to access some day care facilities and day hospital services should they wish to do so. An adequate statement of terms and conditions of residence has now been developed and a copy retained on file. This document addresses costs and rooms occupied as well as other pertinent information. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 10 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 standard(s) 6, 7, 8 and 9. Service user plans are developed for all individuals at the point of admission adequately addressing individual needs, although further work would be beneficial to improve accessibility and understanding. Service users are able to make decisions about their own lives and any restrictions in place are based on risk assessments and care needs. Service users have opportunities to contribute to the daily aspects of life in the home. Risk assessments are completed addressing individual concerns including the required information, although these documents should be rewritten in a more organised and accessible fashion. EVIDENCE: A number of service user plans were viewed at random throughout the course of the inspection. All plans had been completed in sufficient detail addressing needs and actions required. It was noted that the templates do not lend themselves to good care planning practice, with small boxes for the record of interventions. This has led to the care plans being written in a fairly disorganised fashion with insufficient space. A discussion was held with senior staff regarding how this should be rectified. Discussions also took place with some of the service users to determine the level of control that they feel they have over their day-to-day lives. One resident said that “I can go out when I Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 11 like” and the “staff help me when I need it”. Some restrictions are in place, such as no smoking in bedrooms. These restrictions are addressed through appropriate documentation and the rationale made clear to the service users. Residents have input into the activities that they choose to do and the planning of menus for example. The home now organises relatively regular resident meetings, which focus on issues affecting daily life in the home. Risk assessments have been completed and address individual risks, however the management plans do not provide sufficient levels of detail to minimise risks and lack a consistent approach. The documents are disorganised and a number of risks are addressed within each plan, rather than individually. However, it is acknowledged that staff have begun to address the previous lack of any risk assessment and should continue to develop these. Refer to recommendation 2. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 12, 13, 14 and 17. There are adequate opportunities for personal development and recreational activities. Service users are enabled to access the local community and maintain personal relationships. A healthy and balanced diet is provided. EVIDENCE: Service users in the home are able to access resources and participate in activities that promote their personal development. Assistance is given within the home to service users helping with daily living skills such as budgeting, community access and personal hygiene. There are also opportunities to attend external resources i.e. community mental health centres, adult education and the resource house should individuals choose to do so. In addition to this the home has placed a greater emphasis on leisure and recreation. There is a weekly bingo session, but a number of day trips have also been organised to a local bird park and zoo for example. A record is kept of all activities service users have participated in and additional trips have been arranged over the summer months. Many of the residents access the facilities in the town centre including cafes, shops, the library and sea front. One Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 13 resident said that “the staff take me out when I want to”. There is a flexible visitors policy in place and family and friends are welcomed into the home. Menus demonstrate that a healthy, balanced diet is provided with choices. Mealtimes are relaxed and unhurried. One service user stated that “the food is very good”. One of the care staff also works as the main cook in the home; she has a good understanding of the dietary needs of the service users and stated that special diets would be provided if required. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 19 and 20. Healthcare needs are addressed and monitored. Medication systems and records are well maintained. EVIDENCE: The home has established relatively good links with local healthcare professionals including the mental health services. The home has also improved the standard of recording around healthcare needs documenting input received and demonstrating outcomes, although there remains scope for further improvement in this area. Following a service users visit to a GP, nurse or other healthcare professional the service should clearly document interventions advised and record any changes. Refer to recommendation 3. Records are retained in a confidential manner and service users are supported to attend appointments and consultations. Medication administration charts were clear, up to date and well maintained. The home has adequate policies and procedures relating to medication issues. All staff who administer medication have had appropriate training and the home has additional training planned for the near future. Storage facilities are adequate and any controlled drugs are suitably monitored and stored. None of the service users are selfmedicating at the current time, which is an area that the home could focus on in the future enabling greater control for individuals who are assessed as capable to manage their own medication. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 15 Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 16 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 standard(s) 22 and 23. Service users are able to make complaints and air their views appropriately. The home has adequate processes in place to protect service users from forms of abuse. EVIDENCE: The home has a clear and comprehensive complaints procedure in place. A copy of the procedure is on show and is accessible to all. The home aims to deal with any concerns or complaints on an informal basis in the first instance, but formal processes would be instigated should this prove unsatisfactory. The service has recommenced resident meetings, which now take place on a monthly basis enabling service users to air their views/concerns. Minutes are taken at these meetings and issues and action revisited at subsequent meetings. Staff and management are approachable and demonstrated good interpersonal skills when talking to residents. The home has now introduced improved policies and procedures regarding the protection of service users from abuse. Some minor adjustments to these documents were made at the time of the inspection. Some staff have now attended adult protection training. Staff were also able to describe what actions they should take if they suspected any form of abuse. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 17 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 standard(s) 24, 27, 28 and 30. The home provides a relatively comfortable environment, which is maintained in a clean and hygienic manner. Some renewal and redecoration has taken place since the last inspection, but this process should continue. There are sufficient numbers of adequate toilets and bathrooms. EVIDENCE: Homeleigh is a relatively modern home, which is kept at a good standard of cleanliness, is hygienic and free from offensive odours. There is sufficient communal space including a comfortable lounge, large dining/activity room and a smoking room. There is sufficient laundry space and the kitchen is suitable for the needs of the home. There is an enclosed courtyard garden at the rear of the home. Aspects of the home require attention, but improvements have been made since the last inspection. Plans are in place to resurface the garden due to the fact that it is uneven and poses a potential health and safety risk. Some of the flooring, notably in the dining area has been replaced. There remains strip lighting in areas of the home, which do not add to the homeliness of the environment. Refer to recommendation 4. There are sufficient toilets and bathrooms throughout the home that are adequate for the needs of the service users. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 18 Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 35 and 36. Staff are clear about their roles and responsibilities. There are adequate numbers of staff on duty during the day and at night time. The recruitment practices of the home are adequate. Staff training has improved, but shortfalls remain in mandatory and additional training. A system of staff supervision has been developed and staff feel supported. EVIDENCE: Discussions were held with a number of staff members on duty who stated that the service has improved and there is greater clarity over roles and responsibilities. “People know what they should be doing when they come on shift, whereas before it was all a bit chaotic”. Systems have been introduced to assist staff in their roles such as flexible work schedules, which highlight tasks that need to be completed daily by staff and setting aside time to work directly with service users. Staff roles have also been redefined and tasks have been delegated enabling all staff to take on additional responsibilities. The duty rota was viewed and has been updated. There are sufficient numbers of staff on duty with a minimum of 3 staff during the day and 1 waking and 1 sleep-in staff member at night. The home would still benefit from some additional staff as the current staff team have to work a relatively high number of hours per week. This was especially noticeable at the time of the inspection due to staff being off sick and on annual leave. However the duty rotas did not Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 20 demonstrate that any staff were working excessive hours without a break, which was apparent at the previous inspection. Staff personnel files are now kept on site and a number of these were viewed at random containing all relevant information. A programme of staff supervision has now been introduced and, although in relatively formative stages, staff are receiving regular formal 1:1 sessions. Staff members commented that they feel “well supported”. Progress has been made with regard to staff training with a number of the shortfalls in mandatory training having been addressed. This process must continue and further training is planned for the coming months. Some staff have participated in adult protection training and further medication training is booked. It is advised that staff are provided with updates in mental health awareness training. Refer to requirement 1. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40 and 42. The home needs to further develop quality assurance systems including monthly monitoring visit completed by the responsible individual and satisfaction questionnaires. The home has adequate policies and procedures in place. The health, safety and welfare of service users, staff and visitors is generally upheld, although there are shortfalls in staff training and environmental risk assessments need to be completed. EVIDENCE: The service providers visit the home on a regular basis and it was reported that they are supportive and constructive in their approach. It is required, however, that monthly monitoring reports are completed and sent to CSCI demonstrating service user and staff issues, training updates, environmental improvements/issues and the auditing of record keeping. In addition to this the home should set up a system of assessing the satisfaction of service users and other stakeholders on at least an annual basis. Refer to requirement 2. A comprehensive set of policies and procedures are in place, although the accessibility of these could be improved including a full list of contents. A Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 22 number of records and documentation were viewed including fire logs and accident records, which were up to date and accurate. Evidence was available demonstrating that health and safety equipment and facilities are regularly and appropriately maintained. There remain shortfalls in staff training and environmental risk assessments need to be developed for the home. Refer to requirement 3. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 1 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Homeleigh Score 3 3 3 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 3 x 3 H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 23 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score 3 3 3 x x x 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 1 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x x 1 3 x 1 x Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 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 YA3, YA35 Regulation 18 Requirement To ensure that all staff receive mandatory training and provide additional courses such as mental health awareness. To ensure a robust system of quality assurance is in place. To develop environmental risk assessments. Timescale for action On going 2. 3. YA39 YA42 24 23 01/08/05 01/08/05 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. 2. 3. 4. Refer to Standard YA2 YA9 YA19 YA24 Good Practice Recommendations To redevelop the homes own assessment tool. To continue to develop risk assessments ensuring that they adequately cover the perceived risks and management interventions. To continue to improve healthcare records including outcomes and interventions. To continue to address identified environmental issues. Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 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 © 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 Homeleigh H56-H05 S23280 Homeleigh V226251 070605 Stage 4.doc Version 1.20 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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