Inspection on 21/12/05 for Ivydene

This inspection was carried out on 21st December 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ivydene 10/02/09

Ivydene 12/02/07

Ivydene 11/08/05

Ivydene 29/11/04

Ivydene 27/07/04

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

CARE HOME ADULTS 18-65 Ivydene 1 Station Road Ormesby St Margaret Great Yarmouth Norfolk NR29 3PU Lead Inspector Hilda Stephenson Unannounced Inspection 21st December 2005 11:00 Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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 Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ivydene Address 1 Station Road Ormesby St Margaret Great Yarmouth Norfolk NR29 3PU 01493 731320 NO FAX # 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) Mr Charles Martin Mrs Maureen Martin Mrs Maureen Martin Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th August 2005 Brief Description of the Service: Ivydene is situated in the village of Ormesby St Margaret, close to Great Yarmouth, with a variety of facilities provided locally. It is owned and managed by the proprietors Mr and Mrs Martin. It is a two-storey house with an attached bungalow. It has ample communal space for activities and socialising with a large conservatory being the most recent addition. The home is spacious, well decorated throughout and has 16 single bedrooms. The garden is well maintained and there are car-parking facilities at the front of the building. Many of the service users have lived at the home for a number of years. (One of the service users is a relative of the proprietors and is not included in the registered numbers, increasing the overall number to 17.) The home provides long term care and support to the sixteen service users with mental health needs. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit to Ivydene was undertaken as a short unannounced inspection during the morning of 21st December 2005. The evidence to publish this report was obtained by speaking to the residents who were in during the morning, three staff on duty and both proprietors. The home was found to be clean and tidy and dressed with Christmas decorations throughout the lounges, which both residents and staff had completed. The home is registered to provide care and support for a total of sixteen residents and one family member increasing the overall total to seventeen. What the service does well: What has improved since the last inspection? What they could do better: One of the toilet seats was broken and requires replacing. The proprietors manage the home very well with only one requirement being issued at the end of this inspection. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 6 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. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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 Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: The home has not admitted any new residents since the last inspection so none of these standards were inspected on this occasion. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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 the following standard(s): 6,7,8,9 Residents benefit from good care plans written about their personal care, social care and mental health needs. These are reviewed on a regular basis with input from the residents. EVIDENCE: Two care plans were examined and found to contain in depth detail of residents personal care, social, health and mental health needs. Residents are involved at the time the care plans are written by their key worker and are invited to attend regular reviews, to discuss any further development and changes with their care. During the day several of the residents go out with the majority letting the staff know where they are going and approximately the time they will return. When talking with residents it was confirmed that they make their own decisions regarding their daily needs, meet with their key worker when the care plans are reviewed and have there own opinions included. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 10 When checking two of the care plans it was seen to include risk assessments, which are discussed, by the staff and resident, to ensure that both the resident and the staff are aware of their commitment to each other. The care records showed that support was given by visiting Community Psychiatric Nurses and GPs, although the majority of the time the residents visit the GP at the surgery or visit the Consultant Psychiatrist at the local hospital. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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 the following standard(s): 13,16,17 Residents live in a communal setting and meal times are included as part of their socialising. Private individual time is also recognised. Social activities are arranged during the week. EVIDENCE: Each evening a social activity is arranged by the evening staff ranging from pool nights, ladies night including a manicure and skin care, a music and video night, ending with a game of bingo on a Friday night. During the monthly residents meetings these activities are arranged for the following month. While speaking to several residents they confirmed that they go out to work, day care, college or to visit relatives or friends. Their individual interests are included within the care plan and staff encourages residents to continue with their social interests and hobbies. One resident stated ‘I come and go when I want, although I go out to visit my friends regularly during the week’. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 12 Another resident stated ‘I enjoy the nights we play pool and watching a new video’. The residents arrange their own breakfast and lunch with the staff assisting with the teatime meal when the majority of the residents meet up in the dining room. Staff are sensitive towards residents who wish to eat in their own rooms although currently, all the residents meet up regularly during this mealtime. Again during the residents’ monthly meetings the menu is discussed and arranged for the following month. Within the conservatory, a small area of the room has been converted for residents to make their own tea and coffee and has a refrigerator for residents to use. Several of the residents made coffee for the Inspector who wishes to thank them for their hospitality. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 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 the following standard(s): 20 Medication is stored and administered safely. EVIDENCE: The medication charts for two residents were checked and had been completed satisfactorily. The medication in the home is administered in a safe manner and safely stored. Three residents continue to self medicate with relevant risks having been assessed, with lockable facilities in place for the safe keeping of their medicines within their own rooms. The majority of the staff has completed medication administration training. Written procedures are in place for staff to ensure that safe practices are followed. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 22 Residents are assured that their views and concerns are taken seriously due to the home following their own complaints procedure. EVIDENCE: The complaints procedure is displayed in the hall and each resident has a copy in his or her rooms, this also confirms that residents can complain directly to the Commission if necessary. The home retains copies of past complaints with the action taken. Residents and staff commented that they prefer to speak to the Proprietor if they had any concerns. No complaints were received during this inspection. Several residents confirmed that they feel well supported by the staff ‘who always have time to sit and listen’. One of the staff confirmed that residents talk to them if they have any concerns that are taken seriously by the staff, and are dealt with immediately to ensure they don’t become a major complaint, which is good practice. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 24,27,30 Residents benefit from living within a clean and tidy home with plenty of homely communal space. EVIDENCE: Ivydene is a two-storey building with an attached bungalow within the village of Ormesby St Margaret, close to local amenities. A partial tour of the home was undertaken with all of the communal rooms seen. Each resident has their own bedroom where they have their own colour scheme. The home has adequate bathing and toilet facilities situated on both floors. One of the toilets on the ground floor has a broken toilet seat and this requires repairing. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 16 Residents can smoke if they wish although the designated smoking area is now situated outside within a separate glass conservatory or on the patio area. The home has three lounges, a large conservatory that contains dining facilities and coffee making area; a separate dining room is next to the main kitchen. All of the communal rooms are on the ground floor. The home had a major upheaval when the proprietors replaced the flooring in all of the communal rooms, residents were aware of these changes. The lounges have also been redecorated to ensure that residents are provided with a good standard within the home. The proprietors have drawn up a maintenance plan for continuing improvements for the following year, with several of the plans initiated from the residents, which is again good practice. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Residents benefit from being looked after by caring, well trained staff who acknowledge their individual needs. EVIDENCE: During this inspection two senior staff were on duty with a third member of staff assisting one of the residents with her hobby. The proprietors were also visiting. The duty rota was seen and showed that the home has adequate numbers of staff, with extra staff brought in to cover busy periods or organised social events. One of the proprietors, Maureen Martin, manages the home and is available during the week. The home is cleaned on a daily basis. The home does not employ a cook; the care staff having acquired the food hygiene certificate supervises residents when cooking the evening meal. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,42 Residents live in a well managed home ensuring there views are listened to and acted upon. EVIDENCE: Both proprietors visit each day with Maureen Martin managing the home. Barry and Maureen Martin have owned the home for several years and have delegated some of the practices to senior care staff. One member of staff organises the residents meeting each month and monitors the quality assurance system reporting back the findings to the proprietors. These results are recorded and are included within the yearly plan for improvements. Residents confirmed that they feel included with all aspects of the home; with one stating ‘I would not live anywhere else’. Two care plans, a sample of the policies, medication and fire records were checked during this inspection and were satisfactory. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 19 The home is well managed with good practices in place. A loyal well-trained staff team treat residents as individuals within a communal setting, highlighting the risks when appropriate, supporting residents’ individual needs and lifestyle. Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 20 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X X 3 X X 3 X Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 21 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 YA27 Regulation 23.2a Requirement The toilet seat requires replacing on the toilet on the ground floor. Timescale for action 30/01/06 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 Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Ivydene DS0000027469.V274230.R01.S.doc Version 5.1 Page 23 - 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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