Inspection on 10/03/06 for John Turner House - Short Break Service

This inspection was carried out on 10th March 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

John Turner House - Short Break... 27/11/08

John Turner House - Short Break... 14/03/07

John Turner House - Short Break... 11/07/05

John Turner House - Short Break... 15/02/05

John Turner House - Short Break... 11/10/04

John Turner House - Short Break... 17/03/04

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 John Turner House - Short Break Service Rotterdam Road Lowestoft Suffolk NR32 2EL Lead Inspector Jane Offord Unannounced Inspection 10th March 2006 12:30 DS0000037688.V286794.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 DS0000037688.V286794.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. DS0000037688.V286794.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service John Turner House - Short Break Service Address Rotterdam Road Lowestoft Suffolk NR32 2EL 01502 405449 01502 405447 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) Suffolk County Council Mrs Inneka Rae Winser Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000037688.V286794.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include one named service user for a period of 6 months. Date of last inspection 11th July 2005 Brief Description of the Service: John Turner short break unit is located in Lowestoft on a site shared with other Suffolk Social Services for people with learning disabilities. Within walking distance are facilities for example newsagents, grocers, public houses, parks and the Lowestoft college. The main shopping centre is about 15 minutes walk. John Turner short break is a single storey building and consists of a large kitchen/ dining room, spacious lounge with television and video. A smaller lounge with television and music centre is also available the service users. This room has a patio door leading to an attractive garden with a number of focal points such as a summerhouse and fountain. There are five single bedrooms all nicely furnished. Three bedrooms have rise and fall beds to manage service users needs more effectively. There are three separate toilets, two bathrooms with hoists and a shower room. Wheel chair users are able to access all parts of the building. The sixth bedroom has been turned into an activity room with a wide range of equipment such as art and craft materials, a drum, jigsaws and optic lights. DS0000037688.V286794.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 12.30 and 17.00. The manager was present to help with the inspection process. The service had three people residing there for varying periods of time. Another service user was there overnight and a fifth service user was visiting for the second time and staying for tea with the option of staying overnight if they felt able. During the inspection two current service users files, two new staff files and the complaints log were seen. A tour of the building was undertaken and preparation of the evening meal was observed. When the service users returned from their daytime placements they spent time in the large lounge. As two of them were very new to the service and a little apprehensive it was felt unfair to try to interact with the group so the inspector observed the interactions and spoke to the staff. Other documents seen on the day included the health and safety folder, the Control of Substances Hazardous to Health (COSHH) guidelines, the accident/incident records and a new controlled drugs (CD) register. The service felt relaxed and staff interacted with service users in a friendly way encouraging them to take part in the activities happening around meal preparation. The building was clean and tidy with a light airy feel to it. What the service does well: What has improved since the last inspection? What they could do better: DS0000037688.V286794.R01.S.doc Version 5.1 Page 6 Staff files do not contain evidence of all the checks required or a recent photograph of the member of staff. The automatic release on two bedroom fire doors was not functioning properly. The door to the small room where the refrigerator and freezer are standing is not a fire door. The room was hot from heat generated by the motors and also contained combustible material. On a work surface in the room there was a medicine refrigerator that was not locked and contained some insulin pens belonging to a service user who uses the service regularly but was not there on that day. Hand washing equipment was not available in all the toilets and bathrooms and the kitchen had a cloth towel. The kitchen has no separate hand-washing basin and only one sink used for preparing vegetables, washing up some equipment and hand washing. There were four light bulbs in the kitchen that needed changing. Some areas of care and assessment documentation could be fuller and evidence of reviews of the interventions recorded. 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. DS0000037688.V286794.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 DS0000037688.V286794.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): 4. People who use this service can expect to be able to visit and ‘test drive’ the service prior to using it regularly. EVIDENCE: On the day of inspection two service users were paying trial visits to the service. One service user was staying overnight for the second time and although they were still a little apprehensive staff said they were more relaxed then the previous visit. The second service user was fetched from their day placement by the manager to visit for tea. This was the second time they had done this and had previously said they would stay overnight this time. The service user’s parents were to bring their nightclothes when they came to fetch them so the option to stay or return home was left open to see how the service user settled within the service. The longer term aim was so the parents of the service user could access the service for respite care for them. DS0000037688.V286794.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, 8. People who use this service can expect to have an individual plan of care and be consulted and participate on the day-to-day running of the home but cannot be assured that a risk assessment will be in place for all identified areas or that they will have evidence of reviews. EVIDENCE: Two service users files and care plans were seen. The care plans had headings for communication, morning routine, evening routine, personal care, toilet needs, meals and leisure. There were also details of night time needs and any mobility issues, general health and any known risks. One file had a note that the service user ‘thinks there is a step in every doorway and becomes very unsteady’. There was evidence that the interventions were reviewed and updated. There were assessments of need and risk assessments in the files. The risk assessments covered use of household chemical products, slips/falls, burns, use of electrical equipment and challenging behaviour. One file had a note that the service user had ‘no awareness of road safety’. There was no risk assessment to cover that. The manager said that was DS0000037688.V286794.R01.S.doc Version 5.1 Page 10 managed by never allowing the service user out alone. Both files contained a moving and handling assessment but one dated back to 2001 with no evidence of review. It was clear that service users are encouraged to help with household tasks within their capabilities. One service user helped a member of staff peel the potatoes for the evening meal while another laid the table. Staff said some service users prepared their own packed lunches for the next day. The daily records of one service user noted ‘they were very pleased at doing their own packed lunch for tomorrow’. DS0000037688.V286794.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): 12, 15, 16, 17. People who use this service can expect to continue to take part in their planned daily activities, be encouraged to maintain relationships with their family and have a healthy diet offered to them. EVIDENCE: This service offers respite care to a number of individuals who use the service several times a year. Most of the service users attend day placements when they are in the community. The service continues to support their attendance during their short breaks. The file of one service user recorded that they attended Milton Road centre on Mondays and Wednesdays and Lowestoft day centre on Tuesdays, Thursdays and Fridays. One service user has been in the home for a number of months as their previous placement was unable to meet their needs. An assessment of needs has been done and the service user will be moving to a new placement shortly. Part of the assessment indicated that they needed a recognised day place. DS0000037688.V286794.R01.S.doc Version 5.1 Page 12 An appropriate place had been found and the service user had attended the previous week but found it distressing. This week a member of staff had accompanied them and said that the day had gone really well. Staff were observed asking service users where they wanted to sit and offering them drinks of their choice. Assistance to remove outdoor clothing was offered but encouragement was given for service users to manage by themselves. Staff said that family visits were encouraged even though service users were only in the home, usually, for a short period. Members of some families who were not the main carers took the opportunity to visit the service users during their breaks. The food stores were inspected and contained a wide selection of fresh and frozen food. There was fresh beef and pork, sausages, fish fingers and pies. There was also fresh and frozen vegetables, low fat spread, yoghurts and fruit juices. There was a bowl of fresh fruit in the dining room. The small refrigerator in the kitchen contained a choice of spreads for sandwiches including chicken and bacon, and tuna and sweet corn. The evening meal on the day of inspection was chicken casserole, potatoes and vegetables. Service users were given a choice of boiled or mashed potatoes and which vegetable they wanted. They decided on frozen peas, as there were carrots in the casserole. One service user decided they did not want the casserole and would prefer vegetable soup. The member of staff willingly found a tin of soup for them. The menus seen for the week included jacket potatoes, a choice of fillings and salad, roast dinner on Sunday and a takeaway one weekday evening. The service users files recorded likes and dislikes in food. One had noted ‘dislikes liver and fish with bones. Will eat fish fingers and fishcakes’. Another file had recorded that the service user was overweight and was being encouraged to follow a special diet to lose weight. DS0000037688.V286794.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): 18, 19. People who use this service can expect to be well supported and have their emotional and health needs met. EVIDENCE: The care plans seen had individual routines for the way the service user liked to get up and ready for the day and how they chose to prepare for bed. Staff listened to what service users had been doing during the day and encouraged more reticent ones to join in the conversation. One service user was proudly telling people ‘I’ve been on the computer all day today’. Another showed some artwork they had done. One service user who was visiting the service was encouraged to relax by asking about their family, pointing out what was happening in the video that was being shown and trying to distract their attention from the apprehension they were feeling by engaging them in other activities. The service user decided to help peel the potatoes for the meal. They said ‘I must wash my hands first’. The service users files seen contained details of their GP and other health professionals involved with their care such as the community nurse and health visitor. DS0000037688.V286794.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, 23. People who use this service can expect to have any complaints taken seriously and to be protected from abuse and self-harm. EVIDENCE: The complaints policy was not in evidence in the entrance hall but the manager showed that it had been covered by other papers placed on top of it. They agreed to pin a copy on the notice board in the entrance hall so it was easily seen. The complaints log was seen and showed there had been one complaint since the last inspection. It related to an unexplained fracture possibly sustained by a service user during a stay at the home. The incident was thoroughly investigated but remains unresolved. As a result of the incident the home is to have a new piece of equipment to assist in the management of the service user who has returned for some short stays again. Training records showed that staff have received recent Protection of Vulnerable Adults (POVA) training and managing challenging behaviour instruction. On the day of inspection one service user known to have challenging behaviour and be at risk of self-harming was on one-to-one care. An extra member of staff was on duty to ensure the service user was not left alone and at risk, or that other service users were not put at risk. DS0000037688.V286794.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, 29, 30. People who use this service can expect to stay in a home that is clean and have specialised equipment available to help meet their needs but they cannot be assured that all areas will have suitable hand washing materials. EVIDENCE: During the tour of the premises it was noted that there were no unpleasant odours and rooms were light and airy. Corridors were uncluttered and offered plenty of width to manoeuvre wheelchairs. There was level access to the garden from some of the communal rooms. There were grab rails by the toilets and assisted baths and a shower room. In three bedrooms there were ‘high-low’ beds so access was facilitated. A number of hoists were noted with a selection of slings. The laundry was seen and was tidy. The washing machine had a sluice programme. The Control of Substances Hazardous to Health (COSHH) regulations were displayed on the wall along with the correct procedure for managing soiled linen. There was appropriate hand washing equipment in the laundry but not in all the toilets and bathrooms or, as noted earlier in the report, in the kitchen. DS0000037688.V286794.R01.S.doc Version 5.1 Page 16 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): 34, 35, 36. People who use this service can expect to be cared for by well-trained and supervised staff but they cannot be assured that all the required records for recruiting staff will be retained. EVIDENCE: Two new staff files were inspected. One contained a criminal record bureau (CRB) document for a previous employer and the other a CRB for a different job although still with the same local authority. Both files contained only one reference and no recent photograph of the member of staff. There was evidence of monthly supervision meetings and records of the discussions. Training records seen showed that the whole team had updated 1st aid training in October ’05, had POVA training in either September ’05 or January ‘06and had three monthly updates on ‘unisafe practice’. There had also been training offered on moving and handling, COSHH, Sexual Health and Sexual Rights and People with Learning Disabilities. Individual certificates and attendance dates were seen. DS0000037688.V286794.R01.S.doc Version 5.1 Page 17 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): 40, 42. People who use this service can expect that there are policies in place to protect them but cannot be assured that all health and safety or maintenance issues are addressed. EVIDENCE: A number of policy folders were seen during the inspection and were comprehensive in their cover. There were risk assessments in place for challenging behaviour, moving and handling, hepatitis B and one member of staff had a risk assessment for working while pregnant. The accident/incident log was seen and contained a few entries related to minor injuries or challenging behaviour. The door to the room where the refrigerator and freezer are kept is a sliding door and therefore not fire resistant. The motors of the equipment generate a lot of heat and the room was very warm. The manager said that usually the window to the internal courtyard is kept on the latch to manage the problem. There were some shelves in the room that had combustible material on them. DS0000037688.V286794.R01.S.doc Version 5.1 Page 18 During the tour of the premises it was noted that the automatic fire release mechanism on two bedroom doors was not functioning properly. Four light bulbs in the kitchen area needed replacing. The kitchen does not have many storage cupboards or very much work surface for food preparation. There is only one sink that is used for vegetable preparation, washing up and hand washing. It was noted that the new registration certificate was displayed near the main entrance together with a valid certificate of employers insurance. DS0000037688.V286794.R01.S.doc Version 5.1 Page 19 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 1 STAFFING Standard No Score 31 X 32 X 33 X 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X X X X 3 X 1 X DS0000037688.V286794.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES 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 YA6 YA30 Regulation 14 (2) 13 (3) 16 (2) (j) 16 (2) (j) Requirement Risk assessments must be generated for identified risks and show evidence of review. Liquid soap and paper towels must be available in all communal bathrooms, toilets and the kitchen. Hand washing facilities separate from the sink used for food preparation must be made available in the kitchen. Staff files must contain evidence of the checks undertaken for recruitment following those required under Schedule 2. This is a repeat requirement. The automatic fire release mechanisms on bedroom doors must be in working order and regularly checked. A review must be undertaken, if necessary with the fire department, of the room containing the refrigerator and freezer to ascertain if further fire precautions are needed. Light bulbs must be renewed as they burn out. Timescale for action 10/03/06 10/03/06 3. YA30 31/05/06 4. YA34 7,9,19 Sch. 2 10/03/06 5. YA42 23 (4) (c) (iv) 23 (4) (c) (i) 10/03/06 6. YA42 30/04/06 7. YA42 23 (2) (p) 10/03/06 DS0000037688.V286794.R01.S.doc Version 5.1 Page 21 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 YA24 Good Practice Recommendations A review should be undertaken with a view to increasing the food preparation and storage area available in the kitchen. 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