Inspection on 08/01/07 for Norwyn House

This inspection was carried out on 8th January 2007.

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

Norwyn House 23/04/08

Norwyn House 19/06/07

Norwyn House 19/10/05

Norwyn House 18/05/05

Norwyn House 20/10/04

Norwyn House 13/04/04

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

CARE HOME ADULTS 18-65 Norwyn House Norwyn Charmouth Road Raymonds Hill Axminster Devon EX13 5ST Lead Inspector Teresa Anderson Key Unannounced Inspection 8th January 2007 10:30 Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwyn House Address 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) Norwyn Charmouth Road Raymonds Hill Axminster Devon EX13 5ST 01297 35111 Miss Barbara Jill Anning Miss Barbara Jill Anning Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: Norwyn is a detached 3 storied property situated on the A35 near Axminster, Devon. The home offers personal care and accommodation for up to 5 service users with learning difficulties. It operates as a small, family home where service users and the owners and their family live together. All service users are able bodied so the home is not equipped with aids or adaptations. The communal space is on the ground floor and is made up of 2 lounges (the owners and their family tend to use one of these), a large kitchen/dining room and a separate quiet room. Service user bedrooms are on the first floor. Support is provided by the owners, one carer and a cleaner. The house is surrounded by approximately one and a half acres of garden. There is a local bus service and the owners provide transport in the family cars. Ample parking is available. The current levels of fees range from £321.00 to £486.00 per week. Additional information about the home, together with copies of inspection reports, are available direct from the home. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started at 10.30am and finished at 3pm. During that time the inspector spoke with the two (of four service users) who were at home and with the owners/staff. She looked at all the communal areas and at records relating to care planning, medication, monies and safety. She case tracked the care and services offered to service users in order to provide us with an understanding of the quality of care and support provided to the people who live here. Before the inspection the owners filled in a pre-inspection questionnaire providing information about the home. Questionnaires, asking for comments about the home, were sent to all the service users and one was returned, to an advocate, a relative, a care manager and to a healthcare worker and two were returned. What the service does well: Norwyn ensures that people who are considering coming to live here have enough information and visit the home so they can make an informed choice about where to live. Each person who lives here is treated as an individual and is happy living here. Service users are encouraged to live their life to the full and to balance taking risks with staying safe. People who live at Norwyn live as part of a larger family that includes the owners and their two small children. Each service user has their own bedroom which is not entered by anyone else without permission. Service users tend to use one lounge but also have access to the other two. The home does not have any aids or adaptations for people with a disability as all the service users are able bodied. The home is busy and lively. Routines are minimal and relate to managing a busy family home. Organised activities take place. There is a good bus service and the home has transport for service users to use. Visitors to the home are welcomed and service users say their friends can come when they like. Service users say they like the meals at Norwyn and that they eat what they like. The owner helps service users to stay well by ensuring that they see for example their GP, the dentist, the chiropodist and any specialist services that are needed. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 6 People who live at Norwyn are encouraged to ‘speak their mind’ and to make comments and complaints. When asked, in person and in questionnaires, service users said they had no complaints. They are protected from harm through staff training and understanding of ‘safeguarding adults’ practices. There is a very small staff team at Norwyn consisting of the two owners, one carer and a cleaner who occasionally works as a carer. There is usually one or two members of staff on duty during the day and sleeping staff at night. The home is safe and well managed. The owner/manager has consistently demonstrated good practice in relation to caring for people with a learning disability. Service users say they like living here and that they make choices about how they live their lives. 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. The summary of this inspection report can be made available in other formats on request. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is good. People who come to live here can be assured that they have enough information and that the staff will have a good understanding of them and what their needs and desires are. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The four people who currently live at Norwyn have lived here for a long time and there have been no new admissions since the last inspection. The home does have a vacancy at the moment and on the day of inspection someone was visiting the home. These visits are part of the process of finding out if this person likes the home, would like to live there and if they would get on with other service users. During this visit the user walked freely around the home, had tea, chatted with other users and generally saw how the home operates on a day-to-day basis. The owner/manager has since reported that this person has had an overnight stay at the home. Each service user is admitted via social services with whom the home makes a contract. Each service user has a copy of that contract and a Statement of Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 9 Terms and Conditions although service users spoken with could not remember these. However, they say they are happy living here. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. The care planning system in place does not provide information needed to ensure that service users needs and aspirations are satisfactorily met. People are helped to make decisions about their lives and how they live them and this includes managing and taking risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager demonstrates an excellent knowledge of each service user, their needs and idiosyncrasies. In particular she demonstrates an excellent knowledge of what it is that each service user needs to communicate their needs and wants effectively. This has resulted in some service users presenting with less challenging behaviour. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 11 However this knowledge and the techniques used to support service users are not translated into a plan of care. Although each service user has a care plan these have not been updated or reviewed for some time and do not contain the information that the owner/manager shared with the inspector. They do not contain up to date information about the service users goals and aspirations and do not contain how certain behaviours should be managed. One service user, whilst saying they are happy with their life, thought they had not discussed their plan for a while. Whilst this is a small home within which verbal communication between staff and service users works well, care plans should be comprehensive, written and agreed with each service user. Care plans do contain comprehensive risk assessments, although these have not been reviewed or updated for some time. Service users talked of the ‘risks’ they take and the owner/manager talked of the support that had been provided to help service users develop the skills needed to take risks. Discussions with service users indicate that they are helped and supported to make their own decisions. Although, again, documentation of how this occurs and the people involved is sometimes lacking. Service users say they make choices about for example what to do, what to eat and what to wear. Those service users who are able manage their own finances and others are provided with a level of support which protects them but which also ensures that each service user reaches their full potential in this area. Two accounts were checked and these were found to be in order. Records are completely up to date and all receipts are kept for audit purposes. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. People who live here experience a lifestyle that is stimulating and which meets the needs of the service users. The rights of people who have disabilities are protected and promoted by the ethos of the home. People who live here benefit from a diet that is varied and nutritious. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the survey received from one service user and in discussions with service users they say that they can do what they want to during the day, the evening and at weekends. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 13 Activities include family days out, going to a local craft club, going to care boot sales and going out with a carer. Some or all of the service users, if in, will also usually choose to join anyone who is going out in the car for example to the shops or to pick up on the school run. One service user works locally and another spends time with relatives. Relatives and friends of the service users are encouraged to visit the home and their friends/relatives who live there. Routines in the home are similar to those of a very busy family home. One service user told the inspector that they get up when they like (within reason) and go to bed when they like. All bedroom doors have locks and each service user holds their own key. Written permission from the service user is obtained before anyone can enter the service users bedroom if they are not there to give permission themselves. During the inspection service users had access throughout the home and chose whether to be in company or not. Service users say they enjoy the food at Norwyn. Mealtimes are relaxed and informal, in line with a family home. The main meal of the day is served in the evening and drinks and snacks are available all day. A couple of suggestions were made to the inspector which service users thought might suit individual preferences and these were passed on to the owner/manager. Drinks and snacks are available throughout the day. Service users help with the shopping and tend to choose what to eat on a daily basis. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. The people who live here are helped to stay healthy and the management of medications ensures their safety. Personal support is offered to the people who live here in a way that offers choice and promotes independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user is registered with a GP and records indicate that regular visits are made to the dentist and opticians and for preventative health checks. A chiropodist visits service users in the home on a regular basis. Records show that additional medical support is obtained as and when it is required. Systems and records for the receipt, administration and disposal of medications are of a good standard. All medications are kept securely and the manager demonstrates a good understanding of medication used and is keen to support service users to be involved in self medication according to their Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 15 assessed ability. One service user manages their own medication with some support. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. People who live here are protected from harm and can be sure any grievances will be listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received about this home. In the past the owner has carried out extensive work to help empower the current service users to air their views and to make comments and/or complaints. Service users spoken with say they feel comfortable speaking up. They report that the home used to have a book that they could write their anonymous comments in. However, this has recently gone missing. The owner agreed to replace it with a system that is less likely to be removed and which maintains the anonymity of service users. The owner/manager has since reported that this has happened since the site visit. In the survey received and during discussions service users say that they know who to speak with and how to make a complaint. All staff who work at the home have completed training in safeguarding adults and service users say they feel safe. During the inspection service users were comfortable in the company of the staff on duty. The owner demonstrates a Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 17 zero tolerance to abuse of any type and a good understanding of what to do if abuse is alleged or suspected. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The people who live here enjoy an attractive, clean, safe and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Norwyn is a three storey house with a large kitchen/diner, quiet room and two lounges. One lounge tends to be used by the owner-occupiers, but the owner reports that this is available to service users and their visitors if they wish. The house is very busy with people coming and going and this has been described by one visitor as adding to the homeliness. All radiators are covered or have cool touch surfaces to prevent scalding. Some require painting to improve the overall décor of the home. All of the upstairs windows have been fitted with window restrictors to prevent falls. There are no Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 19 adaptations or aids in the home as these are not needed for the people who live here. The laundry equipment is situated in the kitchen, which is unusual in a care home. This has been approved by the Environmental Health Officer. Good management systems are in place to prevent cross infection. An adjacent piece of land has recently been purchased and the owners have rerouted the drive for easier and safer access to and from the road outside and to increase the amount of parking. Service users say they like living at this home. They like having their own bedroom which they say is their private space. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. Recruitment, training and numbers of staff ensures that the people who live here are well supported and are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Normal staffing levels at Norwyn vary between one or two people on duty during the day and one person (sleeping) at night. Staffing is flexible to suit the needs of the service users. Any relief staff needed are provided from within the very small staff team which is made up of the owners, one carer and the cleaner/carer. Since the last inspection all staff have received training in safeguarding adults and in infection control. Informal training takes place in-house and is related to the needs of service users. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 21 Service users say they like the staff and discussed the reasons why with the inspector. For the safety of service users the home has a plan in place giving instructions on who to contact in an emergency. This is of particularly importance when there is only one member of staff on duty. The home has not recruited any new staff since the last inspection. As all recruitment files had been seen previously and were in order they were not reexamined. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. People live in a home that is well managed, is safe and is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Norwyn is also the owner. She has successfully completed the Registered Manager’s Award and has many years experience of working with people who have a learning disability. In the pre-inspection questionnaire the owner/manager reports that appropriate maintenance checks and contracts are in place for systems such as heating and electrics. Appropriate fire checks take place and staff demonstrate Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 23 a good understanding of the service users’ lack of understanding around fire drills and know what to do to compensate for this. Fire drills take place and some service users are ‘fire marshals’. Service users told the inspector they would leave the home if the fire alarm sounded. All staff receive mandatory training including 1st Aid, food hygiene and health and safety although this is due for updating soon. Whilst responses about the home from a care manager, a relative and service users were very positive, the home does not have a formal system of checking the quality of the services provided. Weekly meetings take place where service users talk about what they would like to do in the coming week and where they are encouraged to talk about what might enhance their lives. Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 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 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (1) (2) Requirement You should ensure that each person living at the home has a written care plan as to how the service user’s needs in respect of health and welfare are to be met. You should make this plan available to the service user; you should keep it under review and, after consultation, you should revise the plan as needed. Timescale for action 31/03/07 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 YA24 YA35 YA39 Good Practice Recommendations You should consider painting the radiator covers to enhance the décor of the home. You should carry out refresher training (1st Aid, manual handling and basic food hygiene) for staff as identified on the pre-inspection questionnaire. You should carry out effective quality assurance to ensure that the views of service users underpin all selfmonitoring, review and development of the home. DS0000021991.V321607.R01.S.doc Version 5.2 Page 26 Norwyn House Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Norwyn House DS0000021991.V321607.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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