Inspection on 05/07/05 for Imber House

This inspection was carried out on 5th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Imber House 20/11/08

Imber House 22/11/07

Imber House 04/05/07

Imber House 23/01/07

Imber House 06/09/06

Imber House 07/02/06

Imber House 03/03/05

Imber House 16/08/04

Imber House 15/03/04

Imber House 20/10/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Imber House 412 London Road South Lowestoft Suffolk NR33 0BH Lead Inspector Jane Offord Announced 5 July 2005 th 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. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Imber House Address 412 London Road South, Lowestoft, Suffolk, NR33 0BH 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) 01502 500448 01502 500448 Mrs Patricia Lesley Webb Mrs Patricia Lesley Webb Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3/3/05 Brief Description of the Service: Imber House is a care home for five adults with learning disabilities. It is situated on a main road in the south of Lowestoft close to local shops, a bus route and five minutes from the beach. It is a semi-detached building with accomodation on three floors. The residents occupy the ground floor and first floor whilst the owner and family have bedroom accomodation on the second floor. The kitchen, utility room and dining facilities are shared by the residents and the family. Three residents have bedrooms on the first floor and two on the ground floor. There is a garden and patio area for general use outside. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a week day afternoon and early evening. It lasted five and a half hours and gave the inspector the opportunity to meet all the residents on their return from the day centre or college that they attend regularly. The inspector had access to personal files for three residents, financial records, policies and procedures and staff personnel files. Fire certificates and medication records were also seen. A tour of the premises was given and all five residents showed their bedrooms and talked to the inspector. The manager was available throughout the inspection and one member of staff was spoken with. The atmosphere in the home was relaxed and open. Residents were welcomed home from their day at college or the day centre. There was discussion about the day’s activities and preparation for the following day. Each resident pursued their own activity until supper was ready. There was evidence of compliance with requirements from the previous inspection in the documentation seen. What the service does well: What has improved since the last inspection? The last inspection left a number of requirements, some repeat, relating to the management documentation needed to evidence the working practices of the service. Most of those requirements have been met, with the remaining in hand. There is a clear system for managing the residents’ money which is simple but allows an audit trail. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 6 There is evidence of fire risk assessments having been undertaken and fire drills have been conducted. The manager has compiled a comprehensive folder of policies and procedures for use in the home. 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. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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 Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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, 5 People who use this service can expect to receive a comprehensive service users’ guide to assist them in making their choice of home and a written contract when they take up residence. EVIDENCE: The manager has, in response to a previous requirement, compiled a new Statement of Purpose for the service. A copy was made available for inspection. It contains details of the home and the individual accommodation provided, qualifications and experience of members of staff, a number of policies and procedures, which apply to the running of the home and the safety of the residents, and arrangements for trial admission and admission. The newly produced Service Users Guide also covers some policies and the admission procedure as well as access to advocacy, and a copy of a contract with the fees charged and what they cover. Neither the Statement of Purpose nor the Service Users Guide contain copies of the Aims and Objectives of the service. These need to be added to make complete documents and aid prospective residents in making a choice. Personal files seen contained copies of the resident’s contract. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9 People who use this service can expect to be consulted about their wishes for life in the home and supported to take risks as part of an independent lifestyle of their choice. EVIDENCE: All the residents were pleased to show off their bedrooms. They each said they had chosen their own colours for their room and each one was different, one reflecting their favourite football team. The posters and photos in each room demonstrated different interests ranging from pop stars to sport. One room had special shelves fitted to display some trophies won by the resident for craft activity. The personal records had certificates of achievement obtained by residents at college or the day centre. Reports from college had been signed by residents with comments such as ‘happy to sign’ or ‘does not wish to comment but will sign’. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 10 On return from college and the day centre on the day of inspection all the residents were observed to choose their own activity. Two watched television in the lounge, one went to their room, one shared their day’s activities with a member of staff and one discussed with another member of staff their requirements for the following day. The personal progress records showed evidence of frequent outings the most recent was to the Norfolk Show. The residents talked about what they had seen and done on that day, the tractors, the people and the stalls. There was also talk about the holiday for this year which is proposed to take place in Wales. The group want to go together this year but as there is a difference in age between the residents they have discussed going as two groups to pursue different activities next year. The personal progress record books had been chosen by the individual residents. They had holographic covers, which showed tigers, dolphins and footballers. Risk assessments were seen that supported independent activity. One risk assessment was for a resident to take a shower unaided, another for changing the light bulb in their bedroom. On the recent visit to the Norfolk Show one resident had been so entranced by the activity going on that they were at risk of being separated from the group. A risk assessment has subsequently been developed with the consent of the resident for the use of a ‘safety line’ at future events. The care plans seen concentrated on, mainly, personal care issues. There were some omissions, which need to be corrected. One resident has a problem with their blood pressure that needs to be monitored regularly. A care plan should be developed to reflect this and detail action to be taken if recordings are outside the therapeutic range. Another resident has distinctive verbal communication that the staff all understand but a new staff member or visitor would not. There should be a care plan developed to assist new staff understand the needs of this resident. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15, 16, 17 People who use this service can expect to be supported in family contact, enjoy a healthy diet and be encouraged to take part in personal development and appropriate community activities. EVIDENCE: The manager said that most days the residents attended the local college or day centre. The personal records had copies of certificates awarded for the completion of courses by the residents. One resident had undertaken a course in ‘Self Awareness’. On the day of inspection one resident showed staff the written work and simple sums they had been doing that day. There was written evidence that the residents regularly went out for a meal in the evening to a local public house or fish and chip shop. The residents said they enjoyed those evenings and they also played darts or pool. One resident has realised that if they save money during the week they can play more pool at the weekend. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 12 The menus for the home show a four weekly rotation and include a variety of home cooked dishes. Staff encourage the residents to choose healthy options and there was a selection of fresh fruit available on the day of inspection. Dietary likes and dislikes are recorded in personal details. One resident ‘likes all food from roasts to BBQs’. All residents have family members who maintain some level of contact with them. One resident who lived with their mother until recently is encouraged to visit her regularly as she is in a nearby care home. The death of a family member is recorded and the action taken to support the resident is clearly documented. One resident was unable to attend the funeral of their father so staff accompanied them to the cemetery with flowers at a later date. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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 standard(s) 18,19,20 People who use this service can expect to have their physical and emotional health needs met and receive support for their personal needs as they would like. The policies and procedures for dealing with medication should offer protection to residents. EVIDENCE: Care plans detailed areas where some residents needed encouragement with personal care. Progress notes recorded any episodes of incontinence with appropriate language. Residents were able to chose whether to bath or shower and when they wanted to do so. Getting up time during the week was in time to attend college or the day centre. At weekends breakfast is served more flexibly to allow for a lie-in if residents choose. Care plans and progress records show awareness of emotional needs. One care plan records ‘needs constant reassurance that they will see their family’. Progress notes for one resident record that the resident said ‘I like being here’, and goes on to document moods such as ‘happy’, ‘face fell’, ‘really excited about a new watch’. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 14 There was documented evidence of out-patients appointments for reviews of medication and in one resident’s case blood pressure monitoring. There were also records of dental and optician appointments. Medication Administration Records (MAR sheets) that were seen were completed with no signature gaps. However it was noted that at the times residents were at the day centre there was a signature or initials in the box. The manager said that was because the medication was given at the centre not omitted. It was recommended that the code system was used for that time to indicate that the home staff were not responsible for giving that dose. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 15 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, 23 People who use this service can expect that their concerns will be taken seriously and acted upon however they cannot be assured that the present level of training in Protection of Vulnerable Adults would protect them from abuse. EVIDENCE: There is a complaints procedure that is on display in the entrance hall and can be found in the Statement of Purpose and the Service Users Guide. The procedure needs some alteration to make it a little more robust and allow for a record of any investigation undertaken. Residents were able to tell the inspector what they would do if they had a worry. The policy on Protection of Vulnerable Adults is based on training undertaken in Norfolk and does not reflect the guidance given to people in Suffolk at the present. This was discussed with the manager during the inspection and it was agreed that training in Suffolk must be undertaken urgently and the policy amended in line with the guidance given then. In compliance with a previous requirement there has been a system set up to manage the residents’ monies. All receipts are numbered and logged and the cash balance for each resident is kept separately. This means there is a clear audit trail. All the residents’ personal documents, such as birth certificates and passports are secured in a fireproof document box. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 16 A bank account for each resident has recently been opened and a debit card for each person has been issued. One resident is eager to have their card with them but does not fully understand the purpose of it. There was evidence in the files that the PIN (personal identification number) number issued for that card was still intact. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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, 25, 26, 27, 28, 29, 30 People who use this service can expect to live in clean, safe surroundings with individual and communal rooms that are comfortable, homely and encourage independence. EVIDENCE: Since the previous inspection a new carpet has been laid in the lounge, a fire door has been fitted to the back door and a new stair lift has been ordered, as the existing one is not repairable. There was no evidence of incorrectly stored cleaning materials or chemicals. The residents’ bedrooms were all arranged to suit them with different furniture for their individual interests, for example special cabinets for videos or music collections. Each room had a television point and hand basin, and residents had their own key to their room. The bathrooms and toilets seen were all tidy and free from communal toiletries. It is a hard water area and some taps have a build-up of scale that needs to be removed. The manager explained that there has been a problem with the thermostatic valves that had been fitted and a plumber was due the Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 18 following day to resolve the issue. It was not possible to test water temperatures on the day of inspection because of that. The kitchen, laundry and dining areas were all clean and the home was free of odours. Certificates for all the fire appliances were in date and there was evidence of regular fire training for both staff and residents. The manager had recently fitted emergency lighting on the stairways and supplied two heavy-duty torches, kept in designated places, as additional back up. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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) 34, 35, 36 People who use this service can expect that the staff are trained to meet their needs and well supervised by the manager, they cannot, at present, be assured that the recruitment policy will offer them protection. EVIDENCE: The staff team is small but there is a commitment to undertaking appropriate training. Three senior staff, including the manager, are doing NVQ level 4 in Management and Care. Staff have also done manual handling, food hygiene, Boots medicine administration, first aid and break away courses. The Protection of Vulnerable Adults training was undertaken in Norfolk and needs to be repeated in Suffolk to be sure that the correct procedure is followed for this county. Formal supervision of staff takes place every five to six weeks with the manager. Records of supervision are kept in staff files. It was suggested that the individuals should have their own copies of supervision records as well and the manager agreed to action that. Staff spoken with felt that supervision offered them support and a forum to raise any issue they were unhappy with or felt needed discussion. They told me they had an annual appraisal that identified training and developmental needs. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 20 The confusion around the difference between POVA first and CRB checks needs to be clarified and both checks undertaken for all new staff. All new staff must have two written references prior to commencing in their post. A discussion was held with the manager on the day of inspection on this subject. They confirmed that the staff member awaiting a CRB check was not actually rostered to work yet, they were a member of the family so lived in the house. The staff files indicate training has taken place but there is no overview of a training programme for the team. Training records should be consolidated and a system set up to give a comprehensive picture of all training done and highlight any gaps or updates needed. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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) 37, 38, 40, 42, 43 People who use this service can expect the home to be run with their best interests and welfare being safeguarded by a competent and strong manager with good leadership qualities. EVIDENCE: Following the previous inspection, when a large number of requirements relating to management issues were made, the manager has consulted with the staff team and developed policies, procedures and systems to comply with the National Minimum Standards, with the exception of those already cited in this report. The manager has fifteen years experience in relevant care work and is presently undertaking NVQ level 4 in Management and Care. The manager’s manner was observed, with both residents and staff, to be open and encouraging, valuing comments from everyone. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 22 The service has a comprehensive folder of policies and procedures to protect residents and staff. The folder has been put together based on the National Minimum Standards guidance and covers the necessary areas, with the exception of those policies mentioned in this report that need amendment. The manager said they had involved the staff in the development of the folder and it is available for reference at any time. There was a previous requirement for the production of a viable business plan for the home. The manager said they have begun to compile one but this was not seen on the day of inspection and needs to be followed up at the next inspection. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Imber House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x 3 2 I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 24 Yes 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. 2. Standard 1 23, 40 Regulation 4 (1) (a) 13 (6) Requirement The aims and objectives of the service must be included in the Statement of Purpose. Training in Protection of Vulnerable Adults following the procedures in Suffolk must be undertaken by staff and the relevant policy amended in accordance with the guidance given. All new staff must have the required checks undertaken before starting in post. A business plan for the home must be compiled to demonstrate viability. Care plans must be developed to cover individual needs other thanbasic personal care. Timescale for action 15/9/05 21/8/05 3. 4. 5. 34 43 6 19 25 15 (1) Immediate. 15/9/05 15/9/05 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. Refer to Standard 35 Good Practice Recommendations Training records should be consolidated to give an overview of training needs and the updates required of I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 25 Imber House 2. 3. 4. 22 30 20 mandatory training. The complaint policy should be amended to include a comittment to a written reply and records of investigation undertaken. Taps in bathrooms and hand basins should be kept free of lime scale residue. When medication is not administered at the home the code system on the MAR sheets should be used, not a signature. Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection St Vincent House Cutler Street Ipswich Suffolk, IP1 1UQ 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 Imber House I54-I04 S24558 Imber House V231053 050705 Stage 4.doc Version 1.40 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. 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