CARE HOME ADULTS 18-65
Middle West Middle West Carlton Road South Godstone Surrey RH9 8LE Lead Inspector
Pat Collins Unannounced Inspection 10 January 2006 13:15
th Middle West DS0000013719.V276011.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 Middle West DS0000013719.V276011.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. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Middle West Address Middle West Carlton Road South Godstone Surrey RH9 8LE 01342 893804 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) i.esparont.connect.com Mr Jonathan Georges Esparon Mrs Winifred May Esparon Mrs Winifred May Esparon Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 18-64 YEARS of whom one person may be over 65 years of age of female gender Category LD (E) Of the 10 service users accommodated in the home up to 4 service users of either gender may have a Physical Disability within category PD as a secondary condition to their primary condition of Learning Disability Conditions attached to maximum height of service users accommodated in first floor bedrooms. 15th June 2005 2. 3. Date of last inspection Brief Description of the Service: Middle West is a care home registered for provision of personal care and support for ten adults with learning disabilities. Up to four service users may have a physical disability excluding sensory impairment, as a secondary condition. The building is a detached chalet bungalow, with two bedrooms and bathroom on the first floor. The location of the home is semi-rural within a private residential estate. Transport is provided to facilitate access to nearby South Godstone village and all community facilities. Communal areas are spacious, affording a comfortable lounge, separate dining room, kitchen and large conservatory. A separate utility room is available and office facilities. A wheel chair accessible shower room is available on the ground floor additional to other bathing facilities. Bedroom accommodation is a combination of single and shared occupancy rooms. One of the shared bedrooms on the ground floor has an en suite bathroom. The first floor shared bedroom, single bedroom and bathroom are accessible by a steep, narrow staircase. Accommodation on this floor is subject to specific conditions. The home has a pleasant garden and car parking facilities. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the home’s second inspection for the year 2005/2006. It was unannounced therefore management, staff and service users were not informed in advance of the inspection taking place. The inspection commenced at 13.15 hrs and concluded at 16.00hrs. The provider/manager was on duty and present for most of the inspection. The inspection process included review of progress for compliance with the requirement made at the time of the last inspection. A partial tour of the home was carried out and some records examined. Discussion took place with the home manager and four support workers. At the time of the inspection there were eight service users on the register and seven present in the home. The eighth service user was attending a social educational day centre. The inspector spoke with all service users present in addition to meeting in private with a group of three service users to elicit feedback and views about life at Middle West. The inspector would like to thank the service users, manager and support workers for their courtesy and cooperation during this inspection. What the service does well:
The atmosphere of the home was warm and welcoming. The manager and care staff frequently interacted with service users in a friendly, supportive manner. Their approach was respectful and age-appropriate, demonstrating existence of positive relationships between individual staff members and service users. Service users interviewed were satisfied with their care and stated “Winnie (provider/manager) and staff were very nice”. They stated, “we have lots to do”, describing a range of activities they particularly enjoyed and found fulfilling. They also described a sensitive, caring approach by staff in supporting them with their grief at the loss of a service user who died just before Christmas. A self - advocacy group for service users’ whose placements were funded by Surrey County Council continued. This was held weekly at the home, facilitated by two employees of the Royal Association for the Deaf. Service users had control over their private living space and staff were noted to respect the privacy of bedrooms. Health care needs of service users were met in collaboration with primary and specialist services. The needs of a service user diagnosed with early - onset dementia were safely managed. Discussions with staff demonstrated their understanding of dementia as a medical condition, also awareness of the individual needs of this service user.
Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 6 The home environment was domestic in character, warm, clean and comfortable. There was evidence of an ongoing programme for upgrading and redecoration of the premises. Issues regarding staff retention were discussed with the manager following observation of further staff turnover since the time of the last inspection. Discussions with the manager and staff confirmed commitment to staff training and development. A care assistant was stated to be currently studying for the NVQ in care Level 2 qualification. A senior care assistant who was working out her notice was the only other member of the team who had attained an NVQ Level 2 in care qualification. She had studied some modules of NVQ Level 3. Two care staff employed since the last inspection was stated to have nursing qualifications in their country of origin. The providers have confirmed that be virtue of their RGN qualifications that it has been determined by the Department for Work Permits UK that they hold equivalent qualifications in care at NVQ Level 3. An induction and core training programme was in place for all staff. The manager confirmed current recruitment processes in progress for a care assistant, through an employment agency. This prospective employee was due to imminently take up post. Despite the staff turnover, continuity of care was demonstrated. Staff on duty evidently had complimentary skills and experience to ensure provision of appropriate support to service users. Based on the information available it was concluded that the facilities and services of Middle West met the home’s stated purpose. The home’s management and administration was found to be efficient and effective. What has improved since the last inspection? What they could do better:
Discussed was the need to further develop the care plan of a named service user ensuring a comprehensive protocol in place for management of seizures. Communication from the providers following this inspection confirmed appropriate action taken in this matter. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 7 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. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 8 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 Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 9 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): These standards were not inspected on this occasion. At the time of the last inspection the home was operating effectively in respect of these standards. EVIDENCE: Middle West DS0000013719.V276011.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8. Information available at the time of this inspection demonstrated that each of the standards assessed were met effectively. This gives confidence in the home’s management and operation to recognise and meet the needs and wishes of service users. EVIDENCE: Observations confirmed that service users needs were regularly assessed and reflected in the care plan sampled. Of the three service users interviewed, one was aware of the existence of a care plan and could recall contributing to this process. Though the other two service users were unaware of their care plan it was established that they contributed to parts of the process, using picture symbols as a method of communication. All three considered their needs to be met and expressed satisfaction with their care and operation of their home. When asked to describe what they particularly liked about living at Middle West comments included “ all residents are nice”, “there is a nice atmosphere”, “the staff treat us well”, “staff listen to us, look after us and help us if we need it”. The records and information provided confirmed that service users were encouraged to be as independent as possible within individual capabilities.
Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 11 Service users informed the inspector that staff supported and encouraged them to clean and tidy their rooms. When asked whether anything could be improved one individual commented “it would be nice if we lived near a shop as it is difficult to go to the shops without a car”. The other two service users however emphasised that this was not a problem as staff ensured that all service users received ample opportunity to go shopping and to access community facilities. The day-to-day operation of the home ensured user choice so far as possible in respect of lifestyles and activities, based on assessment of needs and individual aspirations. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12,13,14,15, 16, 17. The home met each of the standards assessed. It was demonstrated that service users were encouraged and supported to be as independent as they could be and lead fulfilling lives within individual capabilities. EVIDENCE: Care plans indicated suitable arrangements for stimulation and involvement of service users in accordance with individual preferences, in community events and educational and vocational activities. They described enjoying classes for literacy, cookery, pottery, arts and crafts and self appearance classes to name just a few of the activities attended. They looked forward to weekly visits to a fast food restaurant, a local coffee shop serving home made cakes and shopping trips. They were encouraged to express choice when purchasing new clothes. On the day of the inspection service users were engaging in various activities. Two service users spent some time engrossed in colouring picture books at the dining table. One individual was knitting and two were supported by a staff member to play a game of cards. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 13 Service users stated that though they had enjoyed Christmas, the Christmas entertainment programme had inevitably been affected by the sudden death of a service user the week before Christmas. Individual service users stated staff had supported them on the morning of the inspection in making their beds and tidying their bedrooms. With the exception of one day placement others were still closed down following Christmas. Arrangements were made to support service users in maintaining family links and friendships. Service users looked forward to a mutual friend visiting them once a week. An advocate regularly visited one service user. Systems existed for involving service users in menu planning. They described sitting down with the manager once a week to discuss food preferences. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 Access to treatment and support from health care agencies was demonstrated. The ageing, illness and death of service users is handled with respect and dignity. EVIDENCE: Service users received regular health checks and referral made to specialists to ensure needs were suitably assessed and met. Care plans sampled demonstrated that the physical and emotional needs of service users were overall addressed. Discussed were the need to implement a protocol for management of seizures, including prolonged and multiple seizures for a named service user who had recently developed the same. It is acknowledged that a care plan was in place for the management of seizures for other service users. Since the last inspection the sudden death of a service user had taken place. Discussions with the manager and individual service users confirmed this had been managed with due sensitivity. Service users all attended the funeral service and one individual had been supported in writing and reading out a poem at the service. Service users informed the inspector that staff had and still encouraged them to talk about their feelings of grief. One said “staff are very good, they help us and comfort us if we cry”.
Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 15 In discussion with the manager she was encouraged to use the opportunity of two vacancies to consider whether changes were warranted to the allocation of bedrooms on the first floor as a result of the ageing process. Any changes in allocation of bedrooms must of course be in consultation with service users and other stakeholders. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. It was demonstrated that service users and relatives views were considered to be important and listened to. Service users were safeguarded by the home’s complaint and adult protection procedures. EVIDENCE: The complaint policy and procedure was clear and a copy was contained in the Service Users Guide. Information received from service users confirmed they would not hesitate to refer complaints to the providers. They also stated that staff were willing to listen to their concerns and try to help if they could. Whilst arrangements did not include service users meetings, service users described systems for consultation with them and to enable them to express their views. The three service users interviewed saw no value in having service users meetings. There had been no complaints since the last inspection. The staff induction and core training programme incorporated adult protection awareness and training. A copy of Surrey’s multi agency vulnerable adult protection procedures was available in the home; a whistle blowing policy and procedure was also in place. The manager and some staff had attended an external adult protection workshop in 2004. Three service users responded “yes” when asked if they felt safe at all times living at the home. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 17 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 This standard was met affording a clean, safe, homely and comfortable environment that is ‘fit for purpose’. EVIDENCE: At the time of the last inspection the home met each of these standards providing accommodation appropriate to the needs of the current service users. All areas viewed were clean and tidy, warm and comfortable. A programme for ongoing upgrading and improvement to the premises was evident. Since the last inspection this included refurbishment of the kitchen, replacement of floor covering in the lounge and dining room and fitting radiator covers throughout the home. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 33, 36 Staffing levels were considered adequate to ensure service users needs were met. The frequency of formal supervision for staff ensured they were adequately supported. EVIDENCE: Staffing levels had been adjusted in accordance with the reduced occupancy levels. The home’s staffing arrangements were observed to offer flexible levels of support to meet the home’s stated purpose and service users’ needs. Staff on duty appeared enthusiastic and committed to supporting service users and to their own personal training and development needs. Observations confirmed further staff turnover since the last inspection though this had not adversely affected continuity of care. Discussed was the impact of this on the home’s NVQ training programme. The provider notified CSCI after this inspection that the NVQ equivalent status of the nursing qualifications of two staff members employed are graded equivalent to NVQ Level 3 by the Department for Work Permits UK. Arrangements were in place for staff to receive individual formal supervision on a quarterly basis. Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 19 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): 37 Observations confirmed provision of effective leadership and direction to staff by the manager to ensure continuity of care and competent management of the home. EVIDENCE: Mrs Esparon is responsible for the day-to-day management of the home and had extensive relevant experience in the care of people with learning disabilities. She had been responsible for the day-to-day management of the home for the last fifteen years. Mr Esparon also possessed extensive relevant management experience and had attained a Diploma in Management Studies in addition to other professional qualifications. Mr Esparon was not involved in the day-to-day management of the home. He was responsible for the home’s strategic and business management, staff recruitment, induction, training, formal supervision and for quality assurance. Observations concluded that the home was being effectively and efficiently managed. Middle West DS0000013719.V276011.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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 3 34 x 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x 3 3 x x x x x x Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 21 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 Middle West DS0000013719.V276011.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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