Inspection on 26/07/05 for Inchmahome Residential Home

This inspection was carried out on 26th July 2005.

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

Inchmahome Residential Home 09/02/09

Inchmahome Residential Home 07/02/06

Inchmahome Residential Home 07/03/05

Inchmahome Residential Home 10/11/04

Inchmahome Residential Home 23/02/04

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Pemdale

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

CARE HOME ADULTS 18-65 Inchmahome 11 The Avenue Trimley St Mary Felixstowe, Suffolk IP11 0TT Lead Inspector Claire Hutton Unannounced 26th July 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. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Inchmahome Address 11 The Avenue, Trimley St Mary, Felixstowe Suffolk, IP11 0TT 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) 01394 285675 None supplied Mr Christopher Hewson Mrs Margaret Finch Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07/03/05 Brief Description of the Service: Inchmahome was opened as a residential home for adults with learning disabilities in 1994. It is registered to accommodate and care for up to four residents. The home is part of the Cephas Community Care group. Inchmahome consists of a single storey building in a residential area of Trimley St Mary, close to all local facilities including the train station. All parts of the home are used by the residents. There are four bedrooms, one of which has en-suite facilities. There is a communal lounge and small dining room. There is a large garden to the rear. There is parking to the front of the home. The home is easily accessible by car and was situated off the main A14. Both the towns of Ipswich and Felixstowe were within easy reach by car or public transport. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a week day in July and lasted for 6.5 hours. Claire Hutton was accompanied by a new inspector, Julie Small who jointly inspected and wrote this report. A tour of the communal accommodation was undertaken, four staff were spoken with, this included the registered manager. All four residents were met, but two only briefly on their return from day services. Records were inspected and this included care records, assessments, staff recruitment, training records and the roter. What the service does well: What has improved since the last inspection? What they could do better: There are two areas for improvement firstly, the environment. The radiator covers would benefit from a coat of paint and the hall carpet is threadbare and must be replaced. There are also items that require replacing such as a fridge, tumble drier and cooker. A plan of replacement, refurbishment and repair with a budget should normally be available. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 6 Secondly, records. All recruitment records for any person working at the home must be available for inspection. The professional guidance from the dietician and the doctor for ‘as and when medication’ must be signed off by them to show that the medical guidance comes from a professional source. The incidents of any disciplinary or misconduct by staff must be notified to the CSCI and it is recommended that the daily statement by care staff have the blank lines crossed through to ensure the record cannot be altered at a later date. 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. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 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 Inchmahome I54-I04 S24422 Inchmahome V240198 050726 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) 2 and 5 Service users can expect that their individual aspirations and needs will be assessed, and to be issued with an individual contract and a statement of terms and conditions, therefore making it more likely that needs can be met by the home. EVIDENCE: Care plans of two service users, one holding an assessment report by social services were examined. Both care plans included pre admission assessments by manager of, likes, dislikes, preferred activities, allergies, medical needs, methods of communication, and needs. Comprehensive care plans for service users were present, including risk assessments, medical appointments and outcomes, methods of working with service users, details of social services review, though one service user had not yet received notes from review, this has been requested by manager. Contracts for all four service users are available within the home. Each service user has a Inchmahome statement of purpose and service users guide in care plans, this is signed and dated by staff when this has been read to service user. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 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 and 10 Residents can expect that their assessed and changing needs and personal goals are reflected in their individual plan, and that information about them is handled appropriately, and that their confidences are kept. EVIDENCE: Care plans inspected show that they are reviewed and updated where required on a six monthly basis. One service users care plan includes details of a gluten free diet. The previous inspection had requested that service user see a dietician to identify that this diet was appropriate for a stated reason, that of behaviour management. A dietician appointment had been arranged and attended by the resident, however, no written clarification from the dietician is available. Therefore, it was requested that a written report is sought from the dietician stating that diet is appropriate to the residents needs, specifically as an aid to manage behaviour. Any restriction on an individuals choice and decision making must only be limited through the assessment process. Care plans are kept on a shelf in the office, which was said to be locked when staff members are not present in the office. These are only available to those who need to know information regarding service users. The residents daily records are kept in A4 diaries, these records identify times of residents Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 10 activities and any issues. The manager should ensure that there are no spaces left between shift recordings. This is to prevent information which may be added at a later date. A discussion with the manager about confidentiality of resident information revealed that the manager is committed to maintaining resident confidentiality to only those who ‘need to know’. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 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) 11,13, 14 and 16 Residents have opportunities for personal development, can expect to be part of the community, have their rights and responsibilities respected and recognised in their daily lives. EVIDENCE: Staff were observed working with residents and they offer choice of daily activity using makaton signs. The residents choice to refuse a proposed activity was respected. Staff were also observed to respect a residents right to privacy when entering bathroom to assist in bathing. The resident had requested a bath at this time and resident was promptly assisted in undertaking this. Care plans and daily records identified personal development activities, such as residents preparing breakfast and dressing. The residents were observed to enter the kitchen supported and choose refreshments and food. Records show residents are provided with and take opportunities of going out into the community and undertaking social activities, such as swimming, walking in Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 12 local area, going to parks, going out to eat, attending work centres, residents also attend CEPHAS drop in centre. That evening residents were planning to go bowling. Every resident had gone out that day, except for one person who choose to remain at Inchmahome. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 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) 19 and 20 Residents can expect that their physical and emotional needs will be met, and that if they wish to administer and control their own medication they can expect to be protected by Inchmahome’s policies and procedures for dealing with medicines. EVIDENCE: Care plans show that residents have attended regular medical and dental health checks, and where required resident’s appointments have been made and attended. Care plans show methods of working with residents who may show signs of distress, and residents individual ways of communicating various emotions. Staff working at Inchmahome appear to know the service users they work with very well and a receptive to their needs, this is evident through discussions and observation with staff. One resident self medicates, there is a procedure for this available and followed by staff in Inchmahome, which allows this to be done as safely by the resident as possible thereby keeping a good balance between the homes duty of care and the residents choice to self determination and personal growth. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 14 Staff were seen to administer medication and this was done appropriately. The home have a sample of staff signatures and initials to track who administered drugs. Medication is audited from one month to the next and the home know how much medication they should have in stock at any given time. The Medication administration record (MAR) was appropriately filled in by staff using the codes available. The manager was aware of a drug change and the need to have a pharmacy printed drug sheet and stated this was being supplied in due course. The PRN or ‘as and when required’ medication instructions had been developed well. This instructions were clear to staff as to when the medication should be administered and in what dosage. The manager agreed to get these individual procedures agreed and signed off by a doctor. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 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 and 23 People who use this service can expect complaints and the protection of vulnerable adults to be taken seriously and therefore ensure as far as possible that residents are protected. EVIDENCE: The complaints procedure formed part of the information supplied to residents. The procedure was on display at the home and had recently been sent to one relative who had requested it. There was no record of complaints to examine as the manager stated that no complaints had been received, but she was clear that if a complaint was received it would be attended to. Investigated and a written outcome sent to the complainant. Staff training records showed that care staff had undertaken training in the protection of vulnerable adults (POVA). Staff spoken to were clear about their duty of care to report such incidents and knew who to contact in such an event. Recruitment records for staff included enhanced CRB’s and the national POVA list was searched. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 16 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) 24,25,28 and 30. Inchmahome environment is comfortable and suits the needs of the individuals who live there. EVIDENCE: Inchmahome is a comfortable environment for people with a learning disability to live. The environment is safe and such precautions as radiator covers are in place. These would benefit from a coat of paint. The kitchen has a locked stable door and residents who are capable have their own access, but those residents who are assessed as at risk are supervised at all times. The home is clean throughout. One bedroom had recently been decorated. Bedrooms are individual and personalised. Bedrooms have a wash hand basin and one has en-suite facilities. There is a bathroom with toilet, bath and separate shower. There was a staff toilet. The lounge is large and has comfortable seating of differing descriptions. There is a TV and plenty of videos along with a computer for residents to use. The garden is large and had a temporary gazebo and modern chairs for residents to use. There were also pets in the garden, that were enjoyed by the residents. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 17 The hall carpet is threadbare and must be replaced. There are also items that require replacing such as a fridge, tumble drier and cooker. A plan of replacement, refurbishment and repair with a budget should normally be available. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 18 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) 32, 34 and 35 Residents at Inchmahome are supported by competent, appropriately trained and qualified staff which allows staff to meet service users individual and joint needs. EVIDENCE: Inchmahome and CEPHAS offer a comprehensive training programme to support staff in their role. Each staff member has an individual training programme, with courses taken from a yearly ‘rolling’ programme. Each individual programme identifies dates for attendance and completion of courses. Courses included are health and safety, POVA, risk assessments, value base, food and hygiene, diversion techniques, learning disabilities, care plan and review, bereavement, team building, develop as a worker, dementia, induction and foundation training. Each staff member is expected to attend these mandatory courses. A senior care worker has level 3 care and D32/33 assessor award, and two care staff have achieved level 3 care and two care staff have achieved level 2 care. In house assessment is provided, as well as external assessment for workers under 25 years by YMCA. The recruitment records for 2 staff were examined and found to meet regulation. Records for two staff working in the home were not available for Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 19 inspection. All recruitment records for any person working at the home must be available for inspection. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 20 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 and 41 People who use this service can expect to find a manager who is competent, approachable and promotes the safety of residents. EVIDENCE: The manager of Inchmahome has achieved NVQ level’s 3 and 4 in care and stated has almost completed RMA award. She has a training and development plan and partakes in training periodically to update her knowledge. Staff spoken with find the manager approachable and open to new ideas. She was however a little defensive with the inspectors, but very cooperative. Record keeping was appropriate and safe and secure. The accident records were examined and were appropriate. It was suggested that the manager obtain a copy of the new style accident books, but the home can keep there record in any form they wish. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 21 Staff have received appropriate training in health and safety matters. The manager is exploring the possibility of changing the type of training staff receive in control and restraint. Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 22 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 x 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x 3 x 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Inchmahome Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 x x I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 12 and 14 Requirement Any limitation on a resident rights are through the assessment process, involving the resident where possible and recorded clearly in the care plan. Therefore the dietician must supply her assessement in relation to one resident to show that the restrictions are in the best interests of the resident concerned. The carpet in the hall must be replaced. Equipment must be in good working order and maintained therefore the tumble drier, cooker and fridge must be attended to. All recruitment records for any person working at the home must be available for inspection. Timescale for action 01/10/05 2. 24 23 (2) (b)(c) 01/10/05 3. 34 19 sched 2 immediate 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 6 Good Practice Recommendations The gaps in the daily statements should be crossed I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 24 Inchmahome 2. 3. 20 42 through to ensure records are not altered at a later date. The prn procedures should be signed off and agreed by a doctor. The manager should obtain a copy of the new style accident books Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 25 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 Inchmahome I54-I04 S24422 Inchmahome V240198 050726 Stage 4.doc Version 1.40 Page 26 - 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. 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