CARE HOME ADULTS 18-65
Little Ewell Barfrestone Dover Kent CT15 7JJ Lead Inspector
Julie Sumner Unannounced 10/08/05 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. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Little Ewell Address Barfrestone, Dover, Kent CT15 7JJ 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) 01304 830930 LArche Mrs Jane Mary Pedersen Registered Care Home 7 Category(ies) of Learning Disability registration, with number of places Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10/02/05 Brief Description of the Service: Little Ewell is one of the houses within the L’Arche (Kent) Community. It is a large detached property set in its own grounds, within the small village of Barfrestone. The main house has accommodation on two floors, with five single rooms for service users. There are a further two service user rooms in an adjacent property, known as the flats. Workshops, activities and project rooms and administrative areas are situated within the grounds.The philosophy of L’Arche is that the people with learning disabilities living in the home are central and are called Core Members. The people in the home to support them with their chosen lifestyle are called Assistants. There is a Home Leader who is the Registered Manager and Deputy Home Leader. The Manager and some staff members are ‘non resident’, however the Deputy House Leader and six Assistants live on the premises with the Core Members, each having their own private accommodation. They work full time. The Home is located in a small village with limited access to public transport or amenities. There is a church and public house nearby, although the nearest bus service and railway station, shops and post office are approximately 1 ½ miles away. The Home has a minibus and car for core member/service user transport. There is off road car parking and extensive well maintained gardens which are accessible to core members/service users. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 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 during the morning of Wednesday 10th August and started at 10:45. All the service users were either on holiday away from the home or relaxing and had not come into the communal parts of the house, so they did not participate in this inspection. Little Ewell continues to be a warm and welcoming home. Service users choose when they want to get up and what they want to do. Support is offered to guide them to develop skills to maximise independence and pursue interests and hobbies. Service users have the choice of whether to participate in group activities or spend time by themselves. The building is old and requires an increasing amount of repair and maintenance. Overall, the home is well maintained and is furnished in a comfortable homely way. Some adaptations have been made to support changes in service users’ mobility and awareness and this is also ongoing as their needs change. Further adaptations are planned for the home and redecoration, with advice from an occupational therapist to enable individuals to maintain as much independence as possible. The staff do have relevant training and have achieved degrees in a variety of subjects including psychology and social care. CSCI considers training with a work based assessment to be beneficial as stated in the national minimum standards for care and therefore NVQ training is also to be encouraged. The L’Arche Community are currently reviewing what kinds of homes and support they need to provide in the community and considering ways to support individuals as their needs change and they get older. The methods of information gathering for the inspection included discussion with the registered manager and staff, touring parts of the home, observing activity in the home, and reading and discussing policies, plans and records including newly designed residents’ folders. What the service does well:
Service users are encouraged to make their own choices in how they spend their time and staff are responsive to their needs. There is ongoing assessment of individuals who have changing needs that are due to health conditions including the onset of dementia. Community health care specialists including a psychologist, who is specialising in dementia, are involved in the support of individuals. It was apparent that the manager and
Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 6 staff team have been able to be flexible and responsive in meeting changing needs. There has been a stable staff team in Little Ewell and this has had a positive effect regarding individual relationships and support. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 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 Little Ewell H56-H05 S23479 Little Ewell V242186 100805 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 Service users can be confident that their current and changing needs will be accurately reflected in their assessment and that they will receive the support to meet their needs and maintain their independence as much as possible. EVIDENCE: Individuals’ assessment of needs were discussed. Specialists including the occupational therapist and psychologist have been involved with ongoing assessments and reviews of care. One service user has had an annual assessment by the psychologist. Specialist advice that has been incorporated into the care support plan. Assessments have also included environmental adaptations that would support changes in mobility and perception. Since the last inspection, one service user needed to move to a nursing home when it was no longer possible to the home and staff team to meet individual assessed needs. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 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 Service users know that their views are listened to and that their personal goals are reflected in their individual plans. Service users can be confident that risks will be managed. EVIDENCE: The service user plan has been developed. Support plans are reviewed six monthly and more frequently if needs change. An additional portfolio style information folder has been designed by the manager with service users. This contains amongst other things: photos of the individual, their family tree, what is important to them, how they communicate, how to determine if they are unhappy where there are limited communication skills, preferred routines and personal details including shoe and clothes sizes. Risk assessments are included in the service user plan. Specialist support has been obtained to ensure that independence skills are maintained and appropriate additional equipment is obtained for support. Risk assessments have been reviewed and modified as needs change. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 10 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) EVIDENCE: Not inspected at this time. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 11 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 21 Personal support is given to service users in the way they prefer. The staff team support service users with changing needs and illness with the assistance of specialists. At present staff support is reactive and further training and increased knowledge of conditions would enable them to be more proactive. EVIDENCE: Routines in the home are flexible. Service users are able to determine when they get up and go to bed. Mealtimes are also flexible. There is a communal dining room where meals are served but service users can choose not to eat with the rest of the group if they prefer. Individual preferences regarding how they like to be supported, have been incorporated into the service user plan. The occupational therapist has observed staff interaction with individuals and has given advice that has been incorporated into the guidelines for staff to give support. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 12 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) EVIDENCE: Not inspected at this time. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 13 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, 29 The standard of the environment within the home is good providing service users with an attractive and homely place to live and planned maintenance is in place to improve identified areas. The changing needs of individuals are being assessed by occupational therapist so that adaptations can be made to maintain independence as much as possible. EVIDENCE: The building has a planned maintenance and renewal programme to accommodate the increasing level of intervention and maintenance required due to its age. The TV lounge has been redecorated and new furniture has been purchased. It looked very attractive and comfortable. The main lounge is showing signs of wear and tear and there was some visible water damage to the ceiling following a flooding accident in the bathroom above. There are plans in place to repair and redecorate this room. Consideration is also being given to the most appropriate floor covering in the lounge to meet individual needs in the home.
Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 14 Aids and adaptations have been made following advice from the occupational therapist. Further consideration is being given to additional adaptations and equipment to meet ongoing changing needs. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 15 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 NVQ training is being offered. EVIDENCE: One member of staff is studying NVQ 3. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 16 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) EVIDENCE: Not inspected at this time. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 17 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 x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x 3 x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 2 x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Little Ewell Score 3 x x 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 18 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 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. 1. 2. 3. Refer to Standard 21 24 32 Good Practice Recommendations Continue to develop knowledge and skills to support service users with deteriorating conditions like dementia. Continue to redecorate and refurbish areas in the home showing signs of wear and tear. Continue to offer NVQ training to work towards meeting 50 of the workforce holding this qualification. Little Ewell H56-H05 S23479 Little Ewell V242186 100805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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