CARE HOME ADULTS 18-65
Occombe House Preston Down Road Marldon Paignton Devon TQ3 1RN Lead Inspector
Judy Cooper Unannounced Inspection 20th October 2005 3:30 Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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 Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Occombe House Address Preston Down Road Marldon Paignton Devon TQ3 1RN 01803 556605 01803 556605 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) Torbay Council Emelyn Jeffries Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users with Learning Disability who may have additional Physical Disability or Sensory Impairment. 18/05/05 Date of last inspection Brief Description of the Service: Occombe House is a large, detached, listed building situated in Preston, Paignton and registered to care for up to twelve adult residents with profound learning disabilities, and who may have additional physical or sensory disabilities. There are separate long term (for up to 8 residents) and short-term care facilities (for up to 4 service users). Service users accessing the short stay unit are more often than not well known to the home, having used the service reguarly for a number of years. The home is also attached to a day service for service users with profound learning disabilities. There are easily accessible level gardens for all residents use. To the front of the home is car parking. The first floor of the home is currently being used for staff purposes only, although the rooms, on this floor, do remain registered. On the ground floor there is a large lobby/hall, which residents sometimes like to sit in. This floor is used by the permanent residents. There is also an office, a large dining room, a lounge, a quiet area, a catering kitchen, a double bedroom, six single bedrooms, two bathrooms (one with a walk-in shower, toilet and assisted bath), and a separate toilet for staff use, sited on this floor. The laundry facilities are situated outside of the building. The shortterm care facilities consist of four single bedrooms, an assisted bathroom, a walk in shower and toilet, and a separate toilet and a kitchen/dining area and lounge, all sited on the lower garden level. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Thursday, late afternoon, to allow the inspector the opportunity to meet with all residents following their return from various day services. Opportunity was taken to tour the premises, examine some records and policies and talk with the manager, assistant service manager, those residents that were able to give some verbal feedback, and observe the staff on duty, whilst in the course of undertaking their normal duties with the other residents. The majority of the core standards were inspected at the last inspection in May 2005 with several being met at that time. Those inspected on this occasion concentrated on resident welfare on a day to day basis as well as looking at those where there had been an identified shortfall. The home is currently owned, and managed, by Torbay Council. However this is to soon change with merger of adult social services and adult health services within Torbay, to form the Torbay Care Trust. What the service does well:
Families and friends of the residents continue to be welcomed and encouraged to visit the home and there are excellent relationships between the residents’ families and the home’s manager and staff. The manager and staff continue to provide a continuity of care, which allows the residents to feel secure. Any changes, either small or large, in respect of resident’s care, continue to be well planned and undertaken. This ensures that any resident with severe learning disabilities, and in many cases limited communication skills, are enabled to understand the change. Staff continue to be sensitive to all the residents’ personal likes, dislikes and individual choices. Residents’ rights to dignity and individuality are upheld at all times. The home’s environment is such that residents are safe to wander freely and so, where ever possible, enjoy a personal freedom due to the environment
Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 6 being maintained in such a way as ensure that those residents, who have limited awareness, are safe at all times. The manager and staff at Occombe House continue to ensure that residents benefit from as many experiences and challenges as they wish, and they use both local community facilities as well as specialised facilities. What has improved since the last inspection? What they could do better:
Quality monitoring information, requested and received from interested parties, regarding the way the home runs, was not made public last year, and an updated audit also now needs to take place. This means that residents and/or their relatives have not been given a recent opportunity to feedback their views of the service and were not previously made aware if any views or suggestions they may have expressed were to be addressed or not. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 7 The review of the home’s policies and procedures still needs to be completed, to ensue that staff are aware of what expectations/guidelines they must work within. The registered provider should ensure the manager is allocated sufficient time to carry out necessary management tasks, within reasonable timescales, therefore ensuring that residents’ care is not compromised. Domestic cover should be increased at the weekends to ensure that the cleanliness of the home can be maintained, without carers staff having to undertake this work, and so therefore not be available to fully concentrate on providing care only. 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. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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 Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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): None inspected on this occasion. EVIDENCE: Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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): 7 Staff remain skilled at identifying residents’ individual needs and preferences about all aspects of their lives. This fully enhances the residents’ overall quality of life generally. EVIDENCE: Residents and/or their families continue to fully involved in planning for all aspects of the residents’ care needs and personal goals. Each resident continues to have an appointed key worker who takes overall responsibility for the resident’s day to day needs. Residents were noted as being able to live their lives as they choose. After the residents returned from their various day activities, all were noted as being able to go to their own room, watch T.V, sit quietly, draw etc. It was also noted that, residents continue to be facilitated by the staff to fully participate in the necessary tasks associated with daily living. It was one resident’s birthday and it was pleasing to note that the resident had enjoyed a special day and had been able to invite a friend for tea and to share her cake. During the inspection a staff handover was held (4.00p.m). During the handover, various daily living tasks were discussed and each resident was
Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 11 appointed a member of the evening staff to support and encourage them with this. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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): 12,17 The staff remain skilled at involving the residents in every-day living activities and therefore they lead fulfilling lives. A good, well planned diet is made available, which helps residents maintain a healthy lifestyle. EVIDENCE: Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 13 One resident who is retired, continues to remain at home during the day and enjoys the facilities of the house, and is supported to undertake a wide range of activities, with a member of staff on a one-to-one basis. He is happy at the home and continues to enjoy listening to his music, or watching T.V in the lounge. He was helped at mealtimes with a staff member ensuring that he was able to enjoy his food, by assisting him as necessary. On the evening of the inspection all other residents returned to the home from their various day activities. Occombe House continues to be considered a part of the local community and residents use local facilities such as the shops, hairdressers and pubs. Visitors are welcomed to the home and a visitors record kept, evidenced that residents were able to have visitors at times to suit them and their visitors. Personal, special, friendships that residents might have outside the home are supported and residents are able to invite their friends back to the home, as in the case of the resident celebrating her birthday who had chosen a special friend to visit for tea, on the day of inspection. The assistant service manager, who has consulted with a dietician, continues to plan healthy, nutritionally balanced meals. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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): 18 Occombe House continues to provide sensitive support and to ensure that residents’ privacy, dignity, independence and control over their own lives is fully maintained. EVIDENCE: Care provided continues to be tailored to each individual resident’s needs. All residents require a high degree of support and again, this was noted as being provided sensitively and efficiently by the staff who were clearly aware of the residents’ needs. Staff were seen helping residents with activities and with some personal care in a professional, appropriate and sensitive manner. Medication administration was also noted as being undertaken correctly, during the inspection, by a senior member of the home’s staff. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 15 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 Arrangements for protecting residents and responding to their concerns remain satisfactory and the manager ensures that residents as far as able, and their families/carers know how to complain. EVIDENCE: The home’s complaint procedure remains satisfactory. There have been no complaints reported either to Occombe House or to the CSCI since the last inspection undertaken in May 2005. The manager and staff manage monies for four residents (others are managed by the residents’ families). These residents all have their own individual savings accounts but also use the Local Authority’s suspense account to hold some of their monies. This allows for instant access to monies as necessary. Currently, due to the organisation changes taking place as described within the summary of this inspection, the issue of ensuring that any residents’ monies held, is being reviewed, to ensure that the practices are in accordance with CSCI’s requirements. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 16 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): 24,30 Occombe House is comfortable, clean, well maintained and provides a safe environment. The lowering of a resident’s window, to enhance the resident’s enjoyment of their room, has not yet taken place. EVIDENCE: The tour of the building showed that the accommodation is comfortable, clean and welcoming and was again being well used by the residents. Some further upgrading of furniture and fittings within some residents’ bedrooms and provision of a new carpet within the respite residents’ lounge, has taken place since the last inspection, which further enhances the residents’ accommodation. The home’s laundry room is well appointed and has adequate laundry equipment to meet residents’ laundry needs. Further upgrading in this area has resulted in a good working environment which fully enables staff to deal the with residents’ laundry requirements. The positioning of two stair gates have been further considered by the management of the home. They feel they do not pose a fire risk, but rather minimise day to day health risks concerning residents and enable residents to be freely mobile within the home.
Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 17 The manager stated that she had applied for monies to allow a window in a resident’s room to be lowered to allow the resident to have view when seated, as recommended by this Commission, as well as applying to have some new replacement windows generally within the home. The monies, to allow for this work, have yet to be approved. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 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): 32,34,35 Residents’ needs are met and supported by an experienced, well trained, stable staff team, but there is not yet sufficient domestic cover employed at weekends to fully meet the residents’ needs. The home’s recruitment procedures were in order, and protects residents, however staff records could not be fully verified as they are held centrally rather than at the home. EVIDENCE: A domestic member of staff still needs to be appointed for weekends to support the care staff and allow them to concentrate on providing for the care needs of the residents, rather than having to undertake domestic duties as well. Staff were again noted as interacting in a friendly, respectful manner with the residents and were also supportive of each other. Training is well planned and supports the staff in providing for the varied needs of the residents. Several care staff hold NVQ 3 and 4 and other role related training continues to be provided regularly to ensure staff are competent within their role and able to provide the necessary support to the residents. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 19 It was again evident, from watching the verbal communications and other interactions that took place between the residents and staff, that the staff and residents have good, meaningful relationships. Staff supervision records have been enlarged since the last inspection to ensure that all relevant areas of the supervision sessions are recorded. There was a record of the recruitment process that takes place within the home, which shows residents are protected by the appointment of suitable staff. However full staff records, including the application form and two written references, were not available for the newly appointed staff member whose records were inspected, being held centrally rather than in the home. This meant that the inspector was unable to verify the suitability of this person’s appointment within the home, although there was a written record to say that the home’s management had seen the relevant documentation and had approved it before it was sent to the Local Authority’s central office. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 20 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): 37,39 The overall management of the home is good but some management tasks are not being finalised within previously agreed timescales. The home’s quality monitoring conclusions from last year have not been made available to residents and /or their families, who therefore remain unaware how their views will be acted upon. Updated quality monitoring has not taken place, therefore not allowing residents and/or their families/ carers the ability to express their views as to how the service is running. EVIDENCE: The assistant service manager, who was present throughout the inspection, were very professional and helpful and clearly had an understanding of the management role within Occombe House. (Discussion again took place at this inspection, with the manager, regarding the allocation of management hours that she continues to have allocated for Occombe House. Currently these are approximately 18.50 per week, with the
Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 21 other part of her role seen as providing management cover for the adjacent day care unit). It was again concluded that, only having this number of hours to work within Occombe House, does not allow her the time to fully implement some of the necessary administration tasks, within the required timescales, which accounts for the identified shortfalls regarding the quality auditing within the home. Suitable quality monitoring took place last year, but has not been undertaken for this year. However the collated findings obtained from the previous years quality auditing had not yet been fed back to residents or their families. The manager and staff maintain a safe environment with appropriate and required checks in place to ensure residents’ health and safety. Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 22 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 x x x x Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 4 x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Occombe House Score 4 x x x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x x x DS0000036987.V251465.R01.S.doc Version 5.0 Page 23 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. 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 Refer to Standard YA26 Good Practice Recommendations The registered provider should continue to give consideration to providing a lower window to a bedroom room on ground floor and so enable the resident to have a view when seated. Previous recommendation. The registered provider should ensure that all staff records, are available for inspection purposes. Staff should be employed in sufficent numbers to meet the needs of the residents at the home. The registered provider should continue to consider ways of ensuring that the management role within the home, is allocated sufficient time to allow the manager to undertake necessary management tasks as identified by this Commission. Previous recommendation. The registered manager should continue to ensure that all the home’s policies and procedures continue to be reviewed regularly and updated by the registered manager. (Previous recommendation). 2 3 4 YA34 YA35 YA38 5 YA40 Occombe House DS0000036987.V251465.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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