Inspection on 23/10/06 for Occombe House

This inspection was carried out on 23rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Occombe House 23/10/07

Occombe House 20/10/05

Occombe House 18/05/05

Occombe House 19/11/04

Occombe House 26/05/04

Occombe House 30/12/03

Occombe House 06/08/03

Occombe House 09/12/02

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

CARE HOME ADULTS 18-65 Occombe House Preston Down Road Marldon Paignton Devon TQ3 1RN Lead Inspector Judy Cooper Unannounced Inspection 23 October 2006 2.00 rd Occombe House DS0000036987.V305470.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 Occombe House DS0000036987.V305470.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. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 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 Care Trust Emelyn Jeffries Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users with Learning Disability who may have additional Physical Disability or Sensory Impairment. 20th October 2005 Date of last inspection Brief Description of the Service: Occombe House is a large, detached, listed building situated in Preston, Paignton and is registered to care for up to twelve adult residents with profound learning disabilities, and who may have additional physical or sensory disabilities. The home was, until December 2005, owned and run by Torbay Council. However a merger of adult social services and adult health services within Torbay, has led to the formation of Torbay Care Trust and it is the Trust that now own and run Occombe House. There are separate long term (for up to 8 residents) and short-term care facilities (for up to 4 service users). There has been no change in permanent resident occupancy for over nine years. Clients using the short stay unit are, more often than not, well known to the home, having, in the main, previously used the service regularly. The short-term care facilities consist of four single bedrooms, an assisted bathroom, walk in shower and toilet, and a separate toilet and a kitchen/dining area and lounge, all sited on the lower garden level. On the ground floor, which is used only by permanent residents, there is a large lobby/hall, which residents sometimes like to sit in. There is also an office, a large dining room, a lounge, a quiet area, a catering kitchen, a double bedroom, six single bedrooms and two bathrooms (one with a walk-in shower, toilet and assisted bath). The first floor of the home is currently being used for staff purposes only, although the rooms, on this floor, do remain registered. There are easily accessible level gardens for all residents use. To the front of the home is car parking. The laundry facilities are situated outside of the building at lower ground level. The home is attached to a day service for service users with profound learning disabilities. The weekly fee at the home is £834. 94. The management keep the inspection report within the home’s office and inform interested parties that they may have access to it at any time. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Monday between 2.00 p.m. and 6.00 p.m. All but one resident, attend outside day care provision, several at the attached, but separately run, day centre and return back to Occombe House at approximately 4.00p.m. Consequently, inspecting within the hours noted, ensured that the management of the home was inspected prior to the return of the residents and therefore allowed time to be spent with the residents during the inspection. The home provides care for residents with severe learning difficulties and as such only two were able to communicate verbally. Therefore observation of the residents at the home was also used to obtain further information as to whether the residents’ needs were being met. The home cares for eight permanent residents and there has been no change in this resident group for over nine years. The home also offers four short term care places, with the vast majority of these residents being known to the home. They have planned regular short term breaks, ranging from a few days to a few weeks. During the visit the opportunity was taken to tour the home, examine appropriate records and policies and talk with the manager and a senior carer, who was providing the required management cover. Several other staff member were also spoken with. Other information about the home, including the receipt of questionnaires from some of the residents (undertaken with help from the staff), relatives, and other interested parties, including visiting professionals has provided further feedback as to how the home performs and all of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well: The management undertakes good admission procedures in respect of any short term resident to ensure that their needs are well known prior to admission and that the correct care is subsequently made available. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 6 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 for. This ensures that any resident with severe learning disabilities, and in many cases limited communication skills, are enabled as, far as is possible, to understand the change. One of home’s main strengths is in the way that staff continue to be sensitive to all the residents’ personal likes, dislikes and individual choices and consistently maintain their rights to dignity and individuality. The manager and staff at Occombe House continue to ensure that residents benefit from as many experiences and challenges as they wish, or seem able to cope with, using both local community facilities as well as specialised facilities. The home’s environment is such that residents remain safe to wander freely and so, where ever possible, enjoy a personal freedom due to the environment being maintained in such a way as ensure that those residents, who have limited awareness, are safe at all times. The management of the home remains experienced and stable and ensure that staff are supported in their caring roles, which ultimately ensures residents are cared for well. What has improved since the last inspection? A new “people carrier” has been donated by the “Claire Milne” Trust. This was organised by the Occombe and Fairwinds Association, many of whom have personal contact with the home, and it has proved to be a great benefit. It had been used on the day of inspection to transport two residents on holiday. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 7 Some general upgrading has been undertaken including the provision of some double glazing units in six residents’ rooms and some general redecorating. Results from the home’s quality monitoring gathering has been made available to allow all who participated to know how the management are addressing their comments. This information was produced in a useful and friendly way to encourage participants to further provide valuable feedback and allow them to have a means of being involved in how the home operates. Additional domestic hours were provided at the weekends and although, currently, there is a vacancy for this post, it is anticipated that the post will be filled in the near future. The management have now ensured that all of the home’s policies and procedures have been reviewed to ensue that staff are aware of what expectations/guidelines they must work within. The manager, although still only officially allocated eighteen and a half hours for overseeing the management tasks within the home, has now ensured all the necessary management tasks have been completed to a good standard. This helps ensure that the home is run efficiently and in the best interests of the residents. What they could do better: Staff records, including references and Criminal Record Bureau checks should be forwarded to the manager, and then kept within the home so as to be available for inspection purposes. This is to ensure that the manager is able to be fully aware of all the newly appointed staff member’s details and so ensure that residents remain protected by the appointment of suitable staff. New members of staff’s induction programmes should be formally recorded to ensure that all new staff receive the necessary training to allow them to provide the required care to the residents. The registered manager should continue with obtaining the nationally recognised management and care qualification, required by this Commission in respect of registered managers. The last recorded visit by a representative of the Trust was in June 2006. These visits should re-commence as soon as possible to ensure that there is a Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 8 monthly audit of the home’s working practices and so consequently ensure residents remain in a well managed setting. 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. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 9 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.V305470.R01.S.doc Version 5.2 Page 10 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): Standard 2. Quality in this outcome area is good. There is a thorough process in place for an assessment in respect of the several short term placements the home is able to offer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Occombe House historically has had a very stable permanent resident group for several years with no permanent admissions within the past nine years. Consequently, admissions are for the short stay unit only. There are four places made available within the short term care unit. On the day of inspection all were taken. The admission process and care records for two of these clients were inspected. It was clear that both of the clients needs had been thoroughly assessed. The vast majority of the clients are previously known to the home, having already had regular short care breaks, or having attended the attached day care centre. However it was pleasing to note that full admission records were undertaken for each separate stay a client had at the home. Social Services contracts were seen to be in place for each admission. It was pleasing to note that, due to the dependency and limited communication skills of the residents admitted to Occombe House, relevant details are obtained from all sources, including care mangers and the resident’s next of Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 11 kin, if appropriate, to ensure that each resident’s needs and aspirations are both correctly assessed and known. The home’s statement of purpose is an easy to understand pictorial format to help residents more fully understand the document. This is a good example of how the management makes information available to the residents. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 12 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): Standards 6,7,and 9. Quality in this outcome area is excellent. The manager and staff are skilled in planning for all aspects of the overall needs and personal goals of the residents. They show both sensitivity and awareness of each resident’s current and changing needs and the staff ensure that residents are involvement as much as possible in planning for their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two short term residents’ care details were inspected in detail. Permanent residents’ care records were also inspected generally. The care plan in each case was very concise and informative and there were personal risk assessments for each client. One outside professional commented: “Risk assessments and other data are always well recorded”. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 13 This ensures that all involved in the care of the resident/client are aware of their needs and what care has been agreed to be made available to best meet these needs. Reviews of permanent residents’ care plans are regularly undertaken (at least six monthly) whilst short term care clients care plans are reviewed at every stay. The plans clearly described how the resident’s needs/choices had changed over time, for example the short term resident whose care was looked at in detail had a sleep record to aid staff to monitor the sleep pattern of the resident. It was noted that a particularly restless night time period had coincided with a change of medication and having this information allowed staff to both understand and manage the situation appropriately. Each resident has an in-depth personal file which includes daily diaries, care plans, risk assessments, as well as any specific information such as if a resident suffers from epilepsy. There is also a “working file” for each resident. This is information that is easily available to all staff on duty, which allows them to have the required immediate information to provide the individually tailored care set for each resident. All records are held securely and with due regard for a resident’s right to confidentiality. Residents and/or their families continue to be fully involved in planning for all aspects of the residents’ care needs and personal goals which ensures all are able to contribute accordingly. Feedback from a short term client’s relative stated: “I am very satisfied with the care X gets. The staff are lovely. I like the fact that the staff at Occombe write in a communications book letting us know how the respite stays went and what activities were done. X is always very happy to go to Occombe House”. Each resident continues to have an appointed key worker who takes overall responsibility for the resident’s day to day needs. Residents were again 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, whilst a drink was provided. Classical music was noted as playing in the background, which allowed for conversation but provided a soothing atmosphere. One resident likes to go to the local shop and buy a local daily paper, which is readily facilitated. The resident then enjoys looking at the paper with staff. Choice was noted being offered to residents that could understand, for example, if they would prefer tea of coffee, for others the staff made a choice based on their knowledge of the resident. It was also noted that, residents continue to be facilitated by the staff to fully participate in the necessary tasks associated with daily living, such as getting ready to have tea. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 14 One resident was very excited about the forthcoming prospect of “Halloween” and staff were noted as helping the resident decide on how to make a mask and spent time discussing this with the resident. Another resident wanted to know who was on duty and it was noted that a staff member took the resident to the staff notice board and was able to visually show the resident as all staff, on duty, have their pictures prominently displayed. When the resident indicated that he wanted to wait up to see the night staff member, re-assurance was given to ensure the resident knew that this would be possible. During the inspection a staff handover was held (4.00p.m). During the handover, residents’ needs were discussed and all staff made aware of any new needs/changes as well as what care support would be needed during the evening. The staff undertake all work with residents in a person centred manner and it is to all the staff’s credit that they continue to remain very motivated in looking at innovative means of further involving residents as much as possible in the choices available to them. Residents therefore continue to be involved/consulted in planning for their care needs as able. One relative made the following comment: “I have always been amazed, and grateful, for the loving care provided to X at Occombe.” Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14,15,16 and 17 were inspected. Quality in this outcome area is excellent. The residents have as active a lifestyle as possible within the constraints of their abilities. Residents’ lives continue to be enhanced by being supported to participate in many varied activities and by making good use of the local, nearby community facilities. All aspects of daily living within the home, continues to be determined, as far as possible, by resident choice whilst healthy and well planned meals are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are offered opportunities to undertake activities including lots of trips out to different places. Those residents who enjoy going out are taken out regularly either individually or in a very small group. None of the residents are able safely to go out alone but they regularly take part in activities outside the home accompanied by staff. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 16 On the day of this inspection two residents had just left to go on holiday accompanied by two staff members. The residents paid for the holiday themselves, with the Trust subsidising some of the staffing and other incidental costs involved in taking the residents away. Other routine activities are regularly provided for all residents. Craft and art materials were noted to be easily available within the home and there were pictures painted by the permanent residents on the walls of the home’s dining room. The staff host a weekly resident’s meeting, for permanent residents, to which all are invited to attend. Minutes were seen from these meetings and it was pleasing to note that the meetings were well attended with staff providing support for those residents less able to communicate. This is a small example of how the staff value and provide each invidual resident with equal opportunities. The staff promote the use of the local facilities as much as possible such as using the local shops, pub etc. Visitors are welcomed to the home and personal, special, friendships that residents might have outside the home are supported and residents are able to invite their friends back to the home if wanted. As the core staff group at the home remains stable, many staff are familiar with residents’ likes and dislikes. It was noted that the agency staff member on duty at the home, on the evening of the inspection, had been to the home several times and was well acquainted with residents’ needs. 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 (he currently benefits from the weekly visits of a music therapist), or watching T.V in the lounge. One resident needs help with eating and this is known by all staff and the appropriate support provided. The assistant service manager, who has in the past consulted with a dietician, continues to plan healthy, nutritionally balanced meals within the home. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 17 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): Standards 18,19 and 20. Quality in this outcome area is good. Staff provide sensitive and flexible personal support and care to maximise the residents’ rights to privacy, dignity, independence and choice over their own life. Staff also have a good awareness regarding the residents’ health and emotional needs which allows the residents to maintain as good health as possible and build feelings of self worth and esteem. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ preferred routines are set out in their care plans. Several of the staff have worked at the home for long periods of time, and so are well aware of their needs and likes and dislikes. They again showed sensitivity for the residents’ dignity throughout this inspection. Personal care is given in such a way as to protect a resident’s’ rights to privacy and all residents presented well. Residents’ clothes were clean and their dress code was very personalised and suitable for their age etc. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 18 Equipment in the home includes two assisted baths as well as other disability equipment, such as wheelchairs, mobile hoist, grab rails and pressure relieving equipment. The management were advised to enquire into obtaining approved cot side protectors for one resident who uses cot sides as it was noted that currently the home is using duvets as protectors which may not give the adequate type of protection Other routine day to day aids are provided such as continence aids, clothing protectors etc. The staff maintain individual risk assessments on each resident and there is a record of any health care intervention. Some residents occasionally require the use of Stesolid (rectal Diazepam). Any staff member involved in undertaking this has receives annual training from trained nurses and there was very detailed plans and other information of how to recognise and address the need for this intervention. Such care ensures residents are fully protected by only experienced staff dealing with this specific need. During the inspection the support given to a resident who had had a seizure was noted and it was pleasing to note the sensitive, yet professional, way this care was delivered in. At the commencement of the inspection the manager was not available having taken a resident to the hospital to be measured for new needed specialist shoes. This evidences that all members of staff are involved in ensuring residents’ needs are met. One feedback comment received from a senior community nurse stated: “Staff contact the Learning Disability team if they have any difficulties for support to problem solve any difficulties”. Another visiting professional stated: “Staff have been very supportive and sensitive to the needs of an elderly carer. Manager and staff will contact me if there are any problems. The home has regular core group meetings and there is a caring attitude by staff”. The residents’ medication was noted as being stored and administered correctly. The home uses a recognised monitored dosage system for permanent residents, whilst short term care residents’ medications is brought into the home in different ways, dependent on how their medication is managed at home. Staff involved in the administration of mediation are well trained, having attended the training provided by the pharmacist supplying the home. This is reviewed regularly. The last training was provided in July this year. Additionally one of the assistant service managers has recently been awarded a national qualification in medication awareness, which took twelve months to undertake and was very in depth. Therefore residents remain protected by having only experienced staff administering medication. Feedback surveys were also received from several of the residents, prior to the inspection, which the staff had filled in on behalf of the residents. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 19 It was evident that the staff who had done this had a very good awareness of the individual residents’ needs/likes and dislikes. However with the one resident who has better communication skills the staff had enabled the resident to comment individually and the comments recorded were noted to be as the resident felt. It was also noted that residents were comfortable and well cared for generally during the inspection. A feedback comment from a visiting professional stated: “ Over the past seven years, through my work, I have always found both staff and management to be professional and caring in their work. Service users appear well cared for and happy with their needs being met”. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 20 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): Standards 22 and 23. Quality in this outcome area is good. There is a satisfactory complaints procedure and arrangements for protecting residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure. This has been recently reissued by the Torbay Care Trust and includes the name and address of the Commission. An easy to understand edition for resident use is also currently being developed using pictures/symbols. The Commission for Social Care Inspection has received no complaints about the service since the last inspection. The home has policies and procedures for adult protection, in line with the local multi-agency code of practice. All staff have received training in adult protection, with some having recently updated their knowledge. Risk assessments are in place in respect of any form of agreed use of restraint such as the use of cot sides. The manager and staff manage monies for six permanent residents (the other two are managed by the residents’ families). Residents have their own individual savings accounts and some use the Local Authority’s suspense account to hold money (up to £200.00). This allows for instant access to monies as necessary. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 21 Any use of monies, held in the home, is checked by two staff members, which ensures that all monetary transactions are undertaken appropriately. All these measures adequately protect residents. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 22 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): Standards 24 and 30. Quality in this outcome area is good. Occombe House is clean warm, comfortable and homely. Residents’ bedrooms are personalised and well furnished. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 23 The tour of the building showed that the accommodation is comfortable, clean and welcoming and was again being well used by the residents. The permanent residents’ bedrooms were very personalised and nicely presented. Short stay bedrooms on the lower ground floor were obviously less personalised, however it was pleasing to note that there was a welcoming picture of each resident occupying each room on each individual bedroom door. It was noted in the case of one short term resident, who was due into the home on the evening of the inspection, that the room had been made welcoming and his picture was already on the door of the bedroom he was to be using. Also it was noted that the short term care residents’ are accommodated in the room of their choice, if possible, whilst staying at the home. One client appears much happier and settled in a specific room and, consequently, the staff facilitate the client having this room whenever possible. Some further upgrading of residents’ bedrooms, with six having had new windows installed and some other areas, including bedrooms, having been redecorated since the last inspection, has further enhanced the overall residents’ accommodation. One stair gate remains in place at the foot of the front stairs, which are currently not used at all by the permanent residents occupying this area. The management feel it does not pose any fire risk, but rather minimises the day to day health risks concerning residents having easy access to risk related areas. A second gate, which was sited on a back exit, has now been removed to ensure easy access for any sleep in staff in the event of having to evacuate the building. Leaving the one gate in place enables residents to be freely mobile and independent within the accessible, but protected areas within the home. A window in one resident’s room still needs to be lowered to allow the resident to have view when seated, as previously recommended by this Commission, however the room, overall, is very pleasant and comfortable and the resident spends a large amount of the time outside of the room. The home’s laundry room is well appointed and has adequate laundry equipment to meet residents’ laundry needs. Adequate infection control measures were seen to be in place including the provision of protective clothing as well as the home having suitable clinical waste arrangements. Staff attend routine infection control training. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 24 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): Standards 32,34 and 35. Quality in this outcome area is good. Residents are well supported by an appropriately experienced and trained staff group. The staff recruitment programme is adequate and protects residents. There are sufficient designated staff on duty to meet the residents’ agreed needs at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota was discussed and it was noted that there were sufficient staff on duty to provide for residents’ needs. It was noted that the home had employed an agency staff member on the afternoon of the inspection to ensure staff numbers were as required. A domestic member of staff has now been allocated at weekends, however although the post was previously filled the post holder has since left. The hours are due to be allocated again, internally, within the Trust. All staff were again noted as interacting in a friendly, respectful manner with the residents and were also supportive of each other. One staff member, who had worked at the home for six years stated: Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 25 “I enjoy working with the clients. They are all such fun. Everyone is different. The more I work with them the more I get to know them, their likes and dislikes and what makes them happy”. Training is well planned and supports the staff in providing for the varied needs of the residents. There is over 50 of suitably trained staff holding National Vocational Qualifications in Care at levels 3 and 4 and other role related training continues to be offered regularly. It was also pleasing to note that other, non care based staff, are also offered appropriate training. One of the home’s cooks is to soon commence a nationally recognised training course in catering For example staff have recently attended training in such areas as the protection of vulnerable adults, infection control, epilepsy and total communication. The manager confirmed that Induction training is provided for new members of staff which includes the Trust’s own induction programme, whilst an in-house induction training programme is provided by the home’s assistant service managers. The Care Trust is not using the previous records for induction training and consequently, as yet, there is no formal record of the induction training provided. However the assistant service manager, with designated responsibility for training, ensures that there is a record kept on the new staff member’s file of what topics have been covered through in-house training. This level of training ensures staff are competent within their role and able to provide the necessary level of support to the residents. Regular recorded supervision takes place and a staff member confirmed that any staff member could request extra supervision if they felt the need for extra support. Training made available is again discussed within a supervision session. This helps ensures staff remain supported and confident in their various roles. 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. The core group of staff remain at the home and are very familiar with the residents’ needs, which helps ensure a continuity of care and a feeling of security for the residents. One comment received back from a relative did indicate that a relative felt the use of agency staff was not the best as: “I sometimes wish more permanent staff were employed and the home did not have to rely on agency staff who are not always familiar with the service users”. However another feedback comment received from an outside professional who has regular contact with the residents and home stated: “I have always found the staff helpful. Communication between myself and the home regarding clients works efficiently”. Another relative stated: “The staff at Occombe home are always very good”. A care staff member stated: “We have a good consistent team that gives reassurance to all service users”. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 26 It was noted that there had been some staff changes since the last inspection with four new staff being appointed. However the full staff records including, in three cases, the two written references, and, in two cases, the Criminal Record Bureau checks were not available as these are currently being held centrally rather than in the home. The manager had taken up verbal references for three of the staff members herself and these were recorded. The manager also stated that the Trust will not appoint a member of staff without the receipt of the references, and any staff member whose CRB was not returned only worked under supervision. However it was not possible to fully verify the suitability of the four new staff members’ appointments within the home, as not all records were available for inspection. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 27 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): Standards 37,39,41 and 42. Quality in this outcome area is good. The home is managed efficiently and well. Staff endeavour to ensure that the home is run in the best interests of the residents. The home provides a safe, secure environment where residents’ safety and well being is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was originally trained as a special needs teacher and is also a registered group analyst. She commenced her Registered Manager’s Award last year but was not able to continue with this as the assessor, appointed to her, was allocated additional work and was not able to continue with the manager’s necessary support. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 28 The manager is hoping to re-commence this again as soon as possible and is registered to do so. Discussion took place, 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 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, can on occasions limit her involvement in the day to day running of the home. However she knows all the residents very well, having worked at the home and day centre for many years. This knowledge currently allows her to be able to manage both establishments to the required standard. Without this knowledge another manager may not be able to undertake both of management roles as required. The manager is supported by two assistant service managers who are well trained and experienced. Both are currently undertaking a level 4 National Qualification in care and management. Both have designated management areas they are responsible for, with the manager then overseeing these two members of staff. The senior carer who was covering the management of the home during one of the assistant service manager’s annual leave, was present throughout the inspection and was very professional and helpful and clearly also had an understanding of the management role within Occombe House. Suitable quality monitoring has taken place within the past twelve months and feedback has been provided to all interested parties as to the findings. Further written encouragement has also been given asking for on going feedback to ensure that all interested parties are able to have a say in the way the service operates, ensuring it is as residents and their families’ want and need. The home also has regular residents, staff, senior carers, and management meetings. The manager and staff maintain a safe environment with appropriate and required checks in place to ensure residents’ health and safety. The home’s fire log book was inspected and seen to be in order. Water regulation is in place and hot surfaces protected. The last recorded visit by a representative of the Trust was in June 2006, although the manager confirmed a further one had taken place in July, but there was no report available from this visit. These visits should re-commence as soon as possible with a record of the visit being given to the manager of the home and made available for inspection. Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 29 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 3 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 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 x 3 x 3 x 3 3 x Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 30 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 2 Refer to Standard YA19 Good Practice Recommendations The management should obtain approved cot side protectors for one resident who uses cot sides. Staff records, including references and Criminal Record Bureau checks should be forwarded to the manager from head office to keep on the home’s file and then kept available within the home for inspection purposes. The registered manager should maintain records of the induction training made available to new members of staff. The registered manager should continue with plans to obtain her registered manager’s award as soon as possible. A representative from the Care Trust should re commence the monthly required regulation 26 visits to the home as soon as possible. YA34 3 4 5 YA35 YA37 YA37 Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 31 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 Occombe House DS0000036987.V305470.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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