Inspection on 02/03/07 for Insight - Eastchurch

This inspection was carried out on 2nd March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Insight - Eastchurch 23/02/06

Insight - Eastchurch 12/10/05

Insight - Eastchurch 22/03/05

Insight - Eastchurch 26/01/05

Similar services:

Thorndene

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Greenacres

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

CARE HOME ADULTS 18-65 Insight - Eastchurch 83 High Street Eastchurch Sheerness Kent ME12 4DF Lead Inspector Sarah Montgomery Key Unannounced Inspection 2nd March 2007 3.10pm Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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 Insight - Eastchurch DS0000023965.V320453.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 Adults 18-65. 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. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Insight - Eastchurch Address 83 High Street Eastchurch Sheerness Kent ME12 4DF 01795 880484 01795 880484 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) Mrs Lynda Jane Cashford Mrs Jacqueline Frances Hales Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: Insight Eastchurch is a home providing 24-hour care and support to 10 adults who have learning disabilities and additional challenging behaviours. It is one of a group of three homes owned by Mrs J Hales and Mrs L Cashford. Mrs Hales is the registered manager of Insight Eastchurch. The home is located in the village of Eastchurch, on the Isle of Sheppey; it is close to all amenities and is on a bus route. Accommodation comprises of 10 single bedrooms, there is a large dining room and two lounges, one of which is a quiet room situated on the first floor. There are pleasant gardens to the front and rear of the property and there are ample parking facilities provided. The statement of purpose and service user guide is kept in the office. All service users are given a copy of the service user guide. The weekly fees are £1913.87. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Sarah Montgomery conducted this unannounced inspection on March 2nd 2007. Evidence was gathered by speaking with senior management, staff, and service users. Several documents were inspected, including care plans, risk assessment and the service user guide. Conversations with service users and staff, reading of care plans, and inspection of policies and individual records, all evidenced that this home is committed to promoting and practicing equality and diversity for all service users and staff. Outcomes for service users are positive, and all information gathered evidences that service users living at this home are leading valued and fulfilling lives. Thirty eight standards were inspected. All achieved an excellent (4) scoring. There are no recommendations or requirements. What the service does well: What has improved since the last inspection? What they could do better: Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 6 No recommendations. 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. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who live in this home have the information they need to make an informed choice about where to live, and can be confident that their needs and aspirations will be assessed and met. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a statement of purpose and service user guide. Both documents contain detailed information about the home, its purpose and the services offered. The service user guide is an excellent document, and is written specifically for the service user group with accessible language and a pictorial format. It exceeds the standards, and explains to service users what kind of services and support are available to them. On the day of inspection a new service user had moved into the home. All assessment documentation was inspected in regard of this service user. The home had gathered an abundance of information. As well as conducting a very detailed assessment themselves, reports were obtained from the current placement, and from health professionals. Time was also spent talking with the service user and their family. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 9 The assessment information evidenced a need for some specialist support. The home has demonstrated to the service user that specialist services will be either available at the home, or the service user will be supported to access specialist services available in community teams. Records viewed evidenced that the needs and aspirations of the service user identified during the assessment period had been incorporated into an initial care plan and risk assessment. This includes guidelines for identified behavioral support. The service user and their family were supported to visit the home prior to moving. They were given copies of the service user guide and statement of purpose. A contract between the service user and the home has been drawn up. This includes all information as stated in Standard 5. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is excellent. Service users can be confident they will be supported to make decisions and choices in accordance with their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To assess compliance with the above Standards, we looked at care plans, risk assessments, person centred plans, individual daily notes, and information from client forum meetings. We also spoke individually to service users and staff. Again, the home has exceeded the Standards in ensuring and evidencing that service users are supported to take control of their lives. This has been demonstrated particularly in the area of care planning. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 11 Three care plans were inspected. This included the care plan for the new service user. For the purpose of inspection, all care plans viewed were cross referenced with assessment documentation and review documentation. Care plans related to assessed needs. Review documentation evidenced that service users changing needs are obsrved and recorded on a daily basis. To assist accurate care planning, the Company’s behavioural therapist collates information regarding service users challlenging needs, communication and behaviour. This informaton is then used to formulate care plans, risk assessments and behaviour guidelines. The information is also used to chart changes in behaviours. This is presented to service users and their representatives at reviews. All care plans are pro active and include risk management strategies. The home has satissfied the criteria for managing risk while at the same time ensuring that service users are support and empowered to lead balanced and fullfilling lives which encompass aspirations for independence, choice and normal living. Some service users at the home have limitations on choices. All risk assessments and care plans fully document the reasons for these limitations. Conversations with individual service users evidenced they have knowledge and understanding of the limitations in place. In addition to care plans, all service users have person centred plans. Service users complete these documents with support from a key worker and their families. All PCP’s are written in accessible language with accompanying pictures. It includes the service user’s life story, what their aspirtations are, how they like to be supported to make choices and decisions, and what they particulaly like or dislike. It gives guidance to staff on how to communicate with the service user. Client Forum meetings ensure the service users have a real say in day to day decision making, and in influencing policy and procedure with a view to being instrumental in developing the service. These meetings are facilitated by an individual not employd by the company. Staff do not have access to the minutes. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. Service users can be confident they will be supported to make choices about their lifestyles, and supported to develop life skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Insight Eastchurch is a specialist service for people with behavioural difficulties. This was not apparent during inspection, with all observations evidencing a calm and enabling environment in which service users were supported to carry out their day-to-day activities in a manner, which was structured and boundaried, while being focussed on meeting individual needs. Inspection of care plans, including behavioural support plans, evidenced that this environment has been carefully created and managed by providing all Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 13 service users with on going assessment which shapes care planning, risk assessment and behavioural techniques. This has meant that even the most challenging of service user has daily opportunities for personal development, takes part in appropriate activities, and is very much a part of the local community. All service users have a weekly timetable. This includes activities in house and community based. A selection of daily notes were read and cross-referenced with weekly timetables. Most activities were carried out, and ones that were not, an explanation of why not were recorded. Some service users spoke to the inspector about life at the home. They commented that ‘it’s good here, I go out a lot’, and ‘ I know who is working with me every day and we do things like going out and going to the pub’. Service users are encouraged and supported to maintain links with their friends and family. Two service users spoke of relationships outside of the home. It was clear during these discussions that the home plays a key role in supporting relationships to continue, and facilitates telephone contact and visits. The inspector shared an evening meal of chicken casserole with service users. It was a lovely meal, tasted wonderful, was nicely presented, and was healthy and nutritious. Service users spoke to the inspector about the food provided at the home and said it ‘was great’. We asked them if they are asked about menus, and whether their choices were taken into account. All service users spoken with praised the food at the home and said they always had meals they liked. Menus are created by consulting with service users on their choices, likes and dislikes. Alternatives are always available should someone not want or like what has been prepared. All menus are sent to a nutritionist for input into healthy living. Sometimes changes are made, and changes are discussed with service users. Staff always eat meals with service users, and use mealtimes as an opportunity for role modelling, a social occasion, and a time to sit down and talk with each other. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is excellent. Service users can be confident that their physical and emotional healthcare needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans regarding support with personal care were read. All care plans were individually written, and encompassed the service user’s assessed needs as well as their preferences regarding how support is provided, including gender care, was recorded. Health plans were inspected. Each service user has an individual health plan, which addresses both current health needs and a health plan devised to encourage healthy living. The health care plans were very detailed. They included a professional diagnosis, a section on medication prescribed, including the reasons for the prescription, when the medication was to be reviewed, and Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 15 any possible side effects. All appointments with health care professionals were recorded including a synopsis and outcome of the visit. All service users have their medication reviewed at least every six months. The home uses a monitored dosage system. MAR sheets and medication storage were inspected. The home has clear audit trails for medication, and inspection of MAR sheets evidenced correct recording. Some service users are prescribed PRN medication. There are clear guidelines for administering this medication. All staff who administer medication have received appropriate training. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is excellent. Service users can be confident that their views will be listened to and acted upon. Service users are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with senior management and staff, observation of staff and service users, and inspection of policies, evidenced that working practice at the home promotes safeguarding of service users. When questioned, staff displayed knowledge of adult protection protocols and are clear on the procedures for responding and reporting any suspicion of abusive practice. Some service users display physical and verbal aggression. All staff has received training in intervention techniques, and the home employs a specialist behavioural therapist who provides training for staff and written guidelines for individual service users. Physical intervention is seen as the last resort by the home, and guidelines inspected evidenced a professional and measured approach to responding to aggressive incidents. The home has a pictorial complaints procedure. All service users have a copy. Service users are encouraged to give their views on the home, and to talk Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 17 about any concerns or complaints. Discussion with one service user evidenced their knowledge about making a complaint, and they said that staff ‘would help them’, and ‘they trusted the staff and would talk to them’. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is excellent. Service users benefit from living in a homely, comfortable and safe, clean and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All communal areas and one bedroom were inspected. A service user showed the inspector around the home. They were clearly proud of their home, and of their bedroom, which was comfortable and furnished to a high standard. Observations during the inspection evidenced that service users felt relaxed and confident in their environment. The home operates a policy of free access to all communal areas. The kitchen is never locked, and service users are encouraged to really feel ownership of the home. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 19 The two lounges are decorated and furnished in a homely and cosy fashion. They have comfortable sofas and television with DVD/video. The dining room is a pleasant spacious room, and has seating for all service users. The kitchen is domestic in size and was clean and inviting. Service users are supported by staff to keep the home clean and tidy. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. Quality in this outcome area is excellent. Service users benefit from being supported and having their needs met by a competent and effective staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection process has evidenced that the home is committed to excellence in service delivery, and that meeting the needs of service users on a day-to-day and long-term basis is the objective for the staff team. Discussions with members of the team, and observations during inspection, evidenced that staff are clear about their roles, have in depth knowledge of the service user group. Staff are given appropriate training and supervision to enable them to carry out their role effectively. The home employs a behavioural therapist and an aspect of this role is to provide training in the areas of communication, crisis Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 21 management, behaviour management, care planning, risk assessment, and autism. The majority of the team have either completed NVQ 3 or are undertaking it. Management ensure that all staff are trained in adult protection, medication administration, first aid, fire safety, manual handling and food hygiene. Staffing levels are high, and reflect the needs of the residents. The rota is flexible to fit around the lifestyles of residents. Most service users have 1-1 support. Staff are allocated a resident to work with each day. The staff member will support the resident for the duration of the shift. This builds positive relationships and ensures continuity. Staff were observed to be motivated, professional and competent. The service has many staff that has been at the home several years. Staff turnover is low, as is staff sickness. Staff informed the inspector that team meetings were regular, and that they were a forum for improving their knowledge and practice by discussions around individual care plans and behavioural techniques. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Service users benefit by living in a home, which has a clear, effective, and innovative management structure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence gathered from inspection of this service concludes that the manager is highly competent, has skills, qualifications and experience, and has sound knowledge of strategic and financial planning. The service provided at this home is innovative and visionary. Residents receive excellent care and support, which is based on meeting, assessed needs and ensuring everyone leads valued and fulfilling lives. Issues of equality and diversity are encompassed in all aspects of service delivery. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 23 Leadership of the staff team is clear. Staff have defined roles, and service users understand the structure in the home. Staff are valued and this is apparent not only in the training provided, but in the systems for providing support and encouraging creative and innovative practice. Service users are valued. They are supported and enabled to affect change in the home through the service user forum, and by being given choice and control over their own lives and decisions made in the home. The manager ensures that service users health, safety and welfare are protected and promoted by having robust policies, and ensuring safe working practice through training and role modelling. Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 4 2 4 3 4 4 4 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 4 32 4 33 4 34 X 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 4 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 4 4 X X 4 X Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Insight - Eastchurch DS0000023965.V320453.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Insight - Eastchurch DS0000023965.V320453.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. 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