Inspection on 23/10/07 for Occombe House

This inspection was carried out on 23rd October 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Occombe House 23/10/06

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 23rd October 2007 2.00 Occombe House DS0000036987.V349400.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.V349400.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.V349400.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 Vacancy Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Occombe House DS0000036987.V349400.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. 23rd October 2006 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 people with profound learning disabilities, and who may have additional physical or sensory disabilities. A merger in 2005 of adult social services and adult health services within Torbay, led to the formation of Torbay Care Trust and it is the Trust that now owns and manages Occombe House. There are separate long term facilities (for up to 8 people) and short-term care facilities (for up to 4 people). There has been no change in the permanent occupancy for over nine years other than through natural causes. People 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 4 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 those living permanently at the home, there is a large lobby/hall, which some of the people like to sit in. There is also an office, a large dining room, a lounge, a quiet area, a catering kitchen, a double bedroom, 6 single bedrooms and 2 communal bathrooms (one with a walk-in shower, toilet and assisted bath) as well as the necessary communal toilet facilities. The first floor of the home is currently being used for staff purposes only due its to more difficult accessibility, although these rooms do remain registered. There are large, easily accessible level gardens for all the people who live at the home’s use whilst, to the front of the home, there is car parking available. The modern laundry facilities are situated outside of the building at lower ground level. The home is attached to a day service for people with profound learning disabilities, which is run completely separately to Occombe. The current weekly fee at the home is £876.69. The inspection report is kept within the home’s office and any interested parties are made aware that they may have access to it at any time. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 5 Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Tuesday between 2.00 p.m. and 8.00 p.m. All of the people who currently live at the home attend outside day care provision, several at the attached, but separately run, day centre or at another local community resource centre and then return back to Occombe House at approximately 4.00p.m. Consequently, inspecting within the hours noted, ensured that the management and general running of the home was inspected prior to the peoples’ return and then allowed a good amount of time to be spent with the people who live at the home. The home provides care for people with severe learning difficulties and as such only two were able to communicate verbally with the inspector during the inspection. Therefore observation of others was also used to obtain further information as to whether their needs were being met. The home currently provides permanent care for seven people who have all been together for several years. The home also has a facility to provide four short-term care places, with the vast majority of the people who utilise these being well known to the home and benefiting from planned regular short-term breaks, ranging from a few days to a few weeks. On the day of inspection one place was being utilised. During the visit the opportunity was taken to tour the home, examine some appropriate records and policies and talk with the current acting service manager as well as one of the home’s permanent assistant service managers. Several other staff members were also spoken with during the inspection as well as one visitor to the home. Other information about the home, including the receipt of questionnaires from two of the people who live at the home (undertaken with help from the staff), several relatives and several staff 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. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 7 What the service does well: Families and friends of the people who live at the home are welcomed, supported and encouraged to visit the home. There are good links between the management, staff and the peoples’ families/carers with good communications upheld. This ensures that the people who live at the home have a strong body of support to help them with their day to day living needs and maintain their family links. Any changes, either small or large, in respect of the peoples’ care, are well planned for. This ensures that the people who live at the home who all have varying ranges of severe learning disabilities, and in many cases limited communication skills, are enabled as, far as is possible, to understand any change. One of home’s main strengths is in the way that staff are sensitive to all the peoples’ needs, personal likes, dislikes and individual choices and how the staff consistently maintain the peoples’ rights to dignity and individuality. In particular credit must be given to all the staff at the home who have helped the people come to terms with two recent bereavements which have had a major impact on all at the home. Sadly one of the people who used to live permanently at the home died earlier in the year after many years at the home and then very unexpectedly the long serving and highly respected registered manger also died a few months afterwards. The sensitive and thoughtful way that the staff have handled these changes/losses has allowed the people to work through their own sense of loss in their very individual ways whilst fully supported by all the staff. The result is that the people have remained happy and settled within the home but have been enabled to express their feelings openly. The people can benefit from as many experiences and challenges as they wish as staffing allows, using both local community facilities as well as specialised facilities. The home’s environment is such that people remain safe to wander freely and so, enjoy a personal freedom due to the environment being maintained in such a way as ensure that those, who may have limited awareness of acceptable risks, are safe. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: The recording of what care is to be provided to the people should build on ensuring it is person centred (i.e. care that is provided only after consulting with the person/their advocate and ensuring it is to the person’s agreement). Consideration should also be given to ensuring that the peoples’ individual personal choices in the areas of sexuality and faith are provided for as required. (Feedback was received, and the acting service manager agreed, that these specific are currently not always fully considered). To ensure the people remain protected an up to date complaints policy must be compiled in such a way so that those people, who have the ability to understand pictorial forms of communication, may have access to this information and so be aware of how to complain if necessary. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 9 Any form of potential restraint used, i.e. the use of a fixed table in front of a person’s chair, must always be regularly risk assessed by the home’s management, with advice sought from outside professionals, as well as agreement obtained from the person and/or their family/advocate as to the use of such restraint. These details must be kept in the individual person’s file at all times. This is to ensure that any form of restraint used is always in the best interests of the individual person and fully meets their individual needs, whilst at the same time respecting their right to freedom and choice. The home’s management must review staffing levels to ensure that there is sufficient staff on duty at all times, particularly at weekends, to fully meet the peoples’ needs. During the inspection there were comments made to suggest that staffing levels are too low, at these times, to allow staff to be able to fully meet all the peoples’ social needs. The management of the home should continue to make National staff training available to allow the home to achieve its target of having 50 percent of the staff working at the home trained to NVQ level 2 in care. This will then ensure that a suitably trained and aware staff group cares for people who live at the home. The Care Trust should consider the appointment of a new permanent registered manager for the service as comments were received which indicated that there were some feelings of uncertainty around the fact that a new permanent manager has yet been appointed, several months after the untimely death of the previous long serving manager. The Care Trust must review the financial arrangements for the safe keeping of the peoples’ monies to ensure that they individually benefit from receiving interest payments in respect of any large amounts held on their behalf. The last recorded visit by a representative of the Trust was in July 2007. These visits should be undertaken monthly to ensure that there is a regular audit of the home’s working practices and so consequently ensure the people remain cared for in a well managed setting. The management of the home must inform the Commission of any untoward incident or accident affecting any person living at the home. This is so that the Commission can be aware of and monitor any such incident and to be aware how the organisation/home responds. This is to ensure the well being of the people who live at the home is upheld. Please contact the provider for advice of actions taken in response to this Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 10 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.V349400.R01.S.doc Version 5.2 Page 11 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.V349400.R01.S.doc Version 5.2 Page 12 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 assessments, prior to admission, in respect of the several short term placements the home offers. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Occombe House, historically, has had a very stable permanent group of people who have lived at the home for several years with no new permanent admissions within the past nine years. Recently one of these people who lived at the home sadly died at the home and the place has not been filled and so there are now seven permanent people living at the home. Admissions are for the short stay unit only. There are four places made available within this unit. On the day of inspection one person was using this facility. The admission process and care records for the person was inspected and it was clear that person’s needs had been thoroughly assessed and were well known. The vast majority of the people, using this facility, are previously known to the home, having already had regular short care breaks, or having attended the attached day care centre. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 13 However full admission records are undertaken for each separate stay a person has in the home’s short term unit. It was pleasing to note that, due to the dependency and limited communication skills of the people using the short term unit at Occombe House, relevant details are obtained from all sources, including care mangers as well as next of kin, if appropriate, to ensure that each person’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 those that are able understand the document in this manner. This is a good example of how the management makes some information available to the people who live at the home at the home. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 14 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 good. The management and staff are skilled in planning for all aspects of the overall needs and personal goals of the people who live at the home. They show both sensitivity and awareness of each person’s current and changing needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The short term person’s care details were inspected in detail whilst some permanent peoples’ care records were also inspected generally. The care plan seen in each case was very concise and informative and there were personal risk assessments for each person. This ensures that all involved in the care of the person are aware of their needs and what care has been agreed to be made available to best meet these needs. One staff member stated: Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 15 “We have to follow the care plans very carefully and the managers always make sure we read them and know of any new changes. We do get to know the people who live at the home we are like a family, it takes time but the people who live at the home teach you themselves what they want and how they want it”. Reviews of permanent peoples’ care plans are regularly undertaken (at least six monthly) whilst those staying in the short term have their care plans reviewed at every stay. The plans clearly described how the person’s needs/choices had changed over time, for example the short term person’s care needs indicated exactly what care needed to be provided and how their personal circumstances had changed and what impact this may have. Every person has an in-depth personal file which includes daily diaries, care plans, risk assessments, as well as any specific information such as if a person suffers from epilepsy. There is also a “working file” for each person. 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 person’s right to confidentiality. In most instances the care plans inspected had been completed by the staff and again reviewed by the staff with little actual evidence to show there had been involvement from the relevant person themselves. However staff are to receive additional “person centred” training to further heighten their awareness of how best to involve the people in their care planning and there has been a commencement of individualising the care plans overall with completion of this intended for March 2008. The home also aims to work in a total communication manner, which involves ensuring that all the people who live at the home have the opportunity to contribute to how their care is delivered even though this may not be through routine verbal communication methods, but by the observation of body language etc. A further new initiative is also being introduced within the home in relation to the recording of information regarding the peoples’ care. This involves using a “life book” which is a communication tool that will be used and shared by all involved in the person’s care, be it staff at the home, parents or any other involved party It is intended that the person will also be supported and enabled to have input into what is recorded. It is hoped that this way of working will become routine at the home, automatically leading to a more person centred approach in regard to how care is delivered to the people who live at the home. Feedback from a short term person’s relative who was spoken with stated: Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 16 “I am confident with the care given at Occombe. I have no problems at all and am happy with X’s stays here”. Other written feedback received prior to the inspection included: “A communications book is completed on every respite stay. Also I am written to after every respite stay, detailing the events of the stay”. “I have never had to raise any issues about X’s care”. The home takes care of X 100 . We are very satisfied with this service. We find the service very reliable. I am very satisfied with everything Occombe House has to offer. X is always very happy and excited to go on their respite visits. The staff are very caring”. “I cannot fault them in respect of keeping me up to date on important issues. The home gives over and above my expectations in relation to support and care of X”. “I always been very satisfied with the care X has when they have short term respite. Occombe House has always been there for me especially in emergencies. I have no complaints at all”. “I cannot praise or thank staff at Occombe House enough for the wonderful way they look after and care for X. I can go away and have a break knowing that they are in a happy place and being taking care of”. A staff member’s feedback stated: “The service is organised very well to ensure the peoples’ needs are catered for”. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 17 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 good. The people have as active a lifestyle as possible within the constraints of their abilities and staff availability. Healthy and well planned meals are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people are offered opportunities to undertake activities including trips out to different places, however some restraints has been put on these due to limited staff available on occasions such as at weekends. The staff also promote the use of the local facilities as much as possible such as using the local shops, pub etc. People were noted as being able to live their lives as they choose. It was noted that after they had returned from their various day activities, they each chose different activities such as going to their own room, watching T.V, sitting quietly, drawing etc, whilst a drink was provided for them on their arrival back. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 18 One person was going to staff member’s house for tea and was clearly delighted at the prospect. This is an example of how the staff try and provide small social extras for the people who live at the home. Another member of staff was noted as bringing in items that she had shopped for in her own time to help decorate the house for the planned Halloween party to be held the following week. Choice was noted being offered to all that could understand, for example, if they would prefer tea of coffee, whilst for others the staff made a choice based on their knowledge of that person. It was also noted that, people continue to be facilitated by the staff to fully participate in the necessary tasks associated with daily living, such as helping put their laundry away with a member of staff if they wished/were able to. One person has a fixed table placed in front of their chair, on occasions, which would be very difficult for the person to remove independently, therefore a risk assessment must be undertaken to ensure that the continued use of this measure is in the person’s best interests and does not unnecessarily compromise the person’s right to freedom at all times. The acting service manager informed the inspector that all the people who live at the home had had a holiday this year, which they had enjoyed. They went in pairs escorted by two members of staff to different places. This was paid for by the people themselves, with the Trust subsidising some of the staffing and other incidental costs involved. Other routine activities are also regularly provided for all at the home. Craft and art materials were noted to be easily available within the home and a new set of drawers has been provided for one person to store their own drawing and hobby materials in as they have quite a collection of which they are rightfully proud. The staff hosts a weekly meeting, for the people who live at the home that live at the home and all are invited to attend. Visitors are openly welcomed to the home and the people who live at the home and the home generally is an integrated part of the local community. The assistant service manager, who has in the past consulted with a dietician, continues to plan healthy, nutritionally balanced meals within the home. A feedback comment stated: The standards of care and food are high” And a staff comment received stated: “The service we provide to the people is second to none. I have worked here to just over a year and I have been really impressed how well they are looked after not just physically but emotionally as well. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 19 All are treated as individuals and giving choices as much as their mental ability allows. They are shown affection and encouraged to make us feel like one big family. I love my job, I have good job satisfaction”. Staff receive equality and diversity training as part of their overall training. The acting service manager has also recently compiled procedures for providing care to people with different faiths, however the following feedback suggests that more work needs to be undertaken in relation to more fully recognising and understanding some of these very sensitive areas of a person’s life: “There is very little consideration given regarding faith or possibly sexual orientation. They tend to do what the majority likes”. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 20 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 18,19,20 and 21. Quality in this outcome area is good. Staff provide sensitive and flexible personal support and care to maximise the peoples’ rights to privacy, dignity, independence and choice. Staff also have a good awareness regarding the peoples’ health and emotional needs which allows them to maintain as good health as possible and build up feelings of self worth and esteem. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Peoples’ preferred routines are set out in their care plans. Some of the staff have worked at the home for long periods of time, and so are aware of their needs, likes and dislikes. All staff observed showed sensitivity for the peoples’ dignity throughout this inspection. A key worker system is in place to ensure each person has an identified person that they know will be able to support them specifically in doing particular individual tasks such a ensuring their bedroom and clothes are tidy etc. Personal care is given in such a way as to protect their rights to privacy and all the people presented well wearing clean, personalised, age appropriate clothing. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 21 Disability 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 to ensure that the peoples’ physical needs can be met as needed. Other routine day to day aids are provided such as continence aids, clothing protectors etc. to ensure that the peoples’ needs are further met. Where specialist care is required the senior staff administering the care receives the required training from external trainers, for example two people who use the short term facility are fed using a PEG feeding device and staff received the required training to be confident to undertake this procedure. This means that anyone with a specialist need will have their care needs met as required. The staff maintain individual risk assessments on each person and there is a record of any health care intervention. However, it was noted that one person had had to be seen by the hospital services after having a trauma following eating. This incident was not reported to the Commission and so the Commission remained unaware of the problem and of the action taken until the inspection took place. From inspection of the action taken it could be concluded that all necessary steps were taken to safeguard the person both at the time of the incident since with precautions put in place to minimise the risk happening again. This evidences that the management and staff do take the necessary action to safeguard the people who live at the home. Some people 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 people are fully protected by only experienced staff dealing with specific needs. During the inspection the support given to a person who had had several seizures prior to the inspection was seen and it was pleasing to note the sensitive, yet professional, way this care was delivered in with the person being kept at home to ensure a close eye could be kept on them and individual care made available. Peoples’ medication was noted as being stored and administered correctly. The home uses a recognised monitored dosage system for the people who live there permanently, whilst short term care peoples’ medications is brought into the home in different ways, dependent on how their medication is managed at home, however full records are kept during their stay. Staff involved in the administration of mediation are well trained, having attended the training provided by the pharmacist supplying the home, which is reviewed regularly and with additional training to be provided in the near future. One of the assistant service managers was previously awarded a national qualification in medication awareness, which took twelve months to undertake and was very in depth. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 22 Since the last inspection the administration of medication is now undertaken by two staff members to ensure that there is no room for error. Both staff sign to state that the medications have been given out correctly. Therefore people remain protected by having only experienced and competent staff administering medication. Feedback surveys were received from two of the people, prior to the inspection, which the staff had filled in on behalf of the people. It was evident that the staff members who had undertaken this had a very good awareness of the two peoples’ individual needs/likes and dislikes. It was also pleasing to note the staff had enabled the people to comment individually and the comments recorded were noted as they had actually stated them. This evidences that staff can correctly represent what a person may be communicating in their own way. It was also noted that all of the people were comfortable and well cared for generally during the inspection. A feedback comment received prior to the inspection stated: “Occombe house feels like home rather than an institution. All of the people are treated as individuals”. As mentioned in the summary the staff have dealt excellently with the two major bereavements that have occurred since the last inspection. It is to the staffs’ credit that the people have been enabled to overcome these losses and carry on with their lives in a positive and caring environment The manager also stated that staff have been trained in dealing with bereavement, which has included customs and beliefs as part of the training. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 23 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 adequate. There is a satisfactory complaints procedure and arrangements for protecting people from abuse, however the complaints policy was not accessible to the people who live at the home, as it had not been provided in an easy read format. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure operating. This is complied by the Torbay Care Trust and includes the name and address of the Commission and a feedback comment received stated: “ There has certainly always been an appropriate response to any concerns raised about the care of the person using the service”, whilst many others confirmed they knew how to make a complaint should they need to. An easy to understand edition for the people who live at the home was however not available which means that people would not be aware of how to complain. The Commission for Social Care Inspection has not received any 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. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 24 All staff receive training in adult protection on a rolling programme, with all due to have completed this by 2008 to ensure that they are kept up to date with how to both recognise and deal with potential abuse which ensures that the people who live at the home are protected from harm. The acting service manager also stated that all staff has received training in mental health consent issues to further inform them of the peoples’ rights. The home maintains a record of any concerns and action taken and have recently introduced incident forms which are completed for all incidents or near misses so that the these can be monitored and appropriate action taken to ensure good risk management. This will further protect the people living at home. The management and staff manage monies for five permanent people who live at the home (the other two are managed by their families). Although the people have their own individual savings accounts some also use the Local Authority’s suspense account to hold money (up to £200.00), which allows for instant access to monies as necessary. However it was noted, that for some, there was much more being held in the suspense account than the agreed £200.00 when normally the monies are transferred to their own individualised accounts. Consequently the people who live at the home could lose the potential to gain interest on their own monies whilst it is held in the suspense account. Any use of monies, held in the home for the people, is checked by two staff members and balances checked daily, which helps ensure that their monies are properly accounted for. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 25 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. Peoples’ bedrooms are individually personalised and well furnished. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the building showed that the accommodation is comfortable, clean and welcoming and is well used by the people who live at the home. The people who live permanently at the home had bedrooms, which were very personalised and nicely presented. Short stay bedrooms on the lower ground floor were naturally less personalised, however it was noted in the case of one short term client, who was staying at the home when the inspection took place, that their room presented as the person wanted and had chosen for their own comfort. Also it was noted that the short-term care clients are accommodated in the room of their choice, if possible, whilst staying at the home, which helps ensure a feeling of continuity for the person when staying. General required upgrading continues to be undertaken as to ensure that the Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 26 building remains of a good standard. Since the last inspection work has commenced to replace the roof of the home. This work has been undertaken very sensitively to ensure that there is the least disruption to the people, for instance staff have ensured that certain rooms have not been affected and that the security of the home and gardens remain in tact. One stair gate remains in place at the foot of the front stairs, which are currently not used at all by the people occupying this area. The management feels 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 window in one person’s room still needs to be lowered to allow the person to have view when seated, as has been previously recommended by this Commission, however the room, overall, is very pleasant and comfortable and the person occupying the room spends a large amount of the time outside of the room. The home’s external laundry room is well appointed and has adequate laundry equipment to meet peoples’ laundry needs. Staff practice infection control measures such as using gloves and aprons, providing clean flannels and towels each day and there is a clinical waste system in place, which all helps protect the people from the risk of cross infection. Staff also attend routine infection control training. The grounds of the home are large, accessible and very pleasant. Recent upgrading to the gardens has further enhanced this area and the people enjoy the facilities provided. Some example of feedback comments received prior to the inspection in relation to the homes’ environment stated: “The home provides a secure, environment adapted as far as possible to meet the diverse and multiple needs of the people living there”. “The service provides good accommodation for clients i.e. good room sizes, plenty of space and a large garden”. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 27 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 adequate. The people are supported by an appropriately experienced and trained staff group however use of agency staff, who may not know peoples very specific needs, can be unsettling for the people who live at the home. The staff recruitment programme is adequate and protects the people. There is not always sufficient staff on duty to meet peoples 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 although there were sufficient staff on duty to provide for the peoples’ care needs there was not enough staff on duty to provide for their social needs, particularly at the weekends when all the people who live at the home are home. At this time there are only four care staff rotered to be on duty with 2 utilised to provide care for the permanent people and two utilised to provide care in the short term unit if there are clients there (which very often there are). Therefore the permanent people do not always have the opportunities to go out escorted by a member of staff (which all the people require), as there are not enough staff available for one or two members to leave the building. There is currently no domestic cover at the weekends either. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 28 This means that at weekends care staff also have to care and provide domestic cover. As all the people are at home and not attending their weekday placement, there are not enough staff to take individual people out of the home on trips which means that they all have to stay in together of go out as part of a larger group. Feedback received indicated that this is seen as a problem by staff and relatives alike, with comments received such as: “It would be nice to have extra staff at weekends to be able to give the people more quality time. This would also enable them to get out about more which would improve their quality of life and choices”. All staff observed during the inspection were noted as interacting in a friendly, respectful manner with the people and were also supportive of each other. Training is well planned and supports the staff in providing for the varied needs of the people who live at the home although staff said that there has been less training this year with one staff member stating that they had not been on any course in over a year and another one that “more training” would be appreciated. The required ratio of 50 of suitably trained staff holding National Vocational Qualifications in Care at level 2 is not being met with only 6 out of the current 20 care staff having the required qualification. This has been due to some staff changes when qualified staff moved on and newly recruited staff did not hold this qualification. However the management intends to ensure that this ratio is reached by continuing to offer this training whilst other statutory and role related training is also made available. This was evidenced by talking with some staff present who confirmed that they had been given training opportunities and a feedback comment stated: “I have been very impressed with the level of training and I am looking forward to achieving my NVQ three which I start at the end of September”. The manager also confirmed that Induction training is provided for new members of staff which includes the Trust’s own induction programme, whilst a more basic in-house induction training programme is provided by the home’s assistant service managers. However the Care Trust is not providing formal records for staff of the induction training provided and consequently there is no formal record to actually evidence that new staff members have received a suitable induction package. 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 the in-house induction programme Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 29 which does evidence that the basic areas, such as health and safety, fire awareness etc have been addressed. This level of monitoring helps ensure that staff are competent within their role and able to provide the necessary level of support to the people. Regular recorded supervision takes place with records seen which also helps ensures staff remain supported and confident in their various roles. A feedback comment from a staff member stated: “I have supervision regularly with my line manager who is available at any time for help and support to myself and other colleagues. I’ve also found a temporary unit manager a great help in advising me in my future development”. It was evident, from watching the verbal communications and other interactions that took place between the people and staff, that they have good, meaningful relationships. A core group of staff remain at the home and are very familiar with the peoples’ needs, which helps ensure a continuity of care and a feeling of security for the people however there was feedback received that indicated that there had been an increased use of agency staff (during one week in October 9 agency staff alone were used, 3 of which did not know the people at the home). Although the management has introduced an induction sheet for an agency worker to be taken through before they commence their shift as well informing them of the fire procedures etc, this greater use of agency staff has caused some feelings of concern with comments received such 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 people”. “I do not think the care staff always have the right skills and experience to look after people properly. There are people who work at the home with no training at all and some reliance on agency staff. At times there are no experienced or skilled staff at the home”. “Sometimes there are staff from the bank that work at the home but they do not have enough knowledge of the individual needs of the people”. “The home should have more permanent staff to avoid the use of expensive agency staff and therefore have employees who know the people well”. “Occasionally have to use agency staff who are unfamiliar with our clients”. The permanent staff are mostly excellent”. It was also noted that there had been some permanent staff appointments made since the last inspection. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 30 The recruitment records were inspected and were seen to be in order and a staff’s feedback comment confirmed this with: “Although I was already working in care and had an enhanced criminal record bureau check my employer sent one of their own. References were sought. Every aspect of my job was covered by the induction”. A general comment received, regarding the staff, stated that there was: “Very friendly and caring staff employed at the home” whilst two staff members fed back the following regarding their feelings about working at Occombe House: “We are constantly learning about people who live at the home and the ongoing training and support of your fellow colleagues is a big part of being able to do your job properly”. “ I love working here. It is rewarding, the people are great and it is the best job I have ever had”. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 31 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): 37,39,42 and parts of standard 43. Quality in this outcome area is adequate. Due to unforeseen circumstances the management of the home has changed. As there has not been any definite proposals put in place regarding the future of the management team this is causing general insecurity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the previously, long serving manager sadly and unexpectedly died. This caused a great deal of upset for all concerned and it is to the credit of the acting service manager and all the other permanent staff that the people have been able to come to understand the changes and have been supported through this very difficult and sensitive time. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 32 The acting service manager, who is very experienced, is currently also the registered manager for another establishment, within the Care Trust, which provides care for people with less severe learning difficulties. However as historically both houses have undertaken work together, the acting service manage already had a great deal of personal knowledge regarding the people who live at Occombe House which has helped provide a sense of continuity at this difficult time. She is qualified to the appropriate standard, having the registered managers award as well as national vocational qualification at level 4 in care. She is also a registered general nurse although her registration has lapsed. She is supported by two assistant service managers who are both well trained and experienced and have worked at the home for some time. One has almost completed her level 4 National Qualification in care and management, whilst the other is due to commence training for the care award this autumn. Both have designated management areas they are responsible for, with the acting service manager overseeing these two members of staff. A representative from the Torbay Care Trust does usually visit monthly, however the last recorded visit was in July this year. These visits should continue to be monthly to ensure that there is good monitoring in place, particularly in view of the recent change of circumstances, which has affected the home. Some feedback from the peoples’ family members and from staff indicates that there is a great deal of uncertainty about the future of both the management of the home and the actual home itself, for example: “What is in the mind of the Trust in relation to future management issues is both a mystery and the cause of great concern”. “I would like to see the management issue sorted out sooner rather than later. Sharing management with Baytree house is unsatisfactory and is unsettling for both clients and staff. The clients are picking up on the unsettled vibes of the staff and Occombe is not the happy, settled place it was six months ago. This should be addressed as a priority before more harm is done to the clients”. “We are very concerned at the possibility of Occombe house being sold and the people being moved from a home where they are all well and cared for and very happy”. It is understood that the Care Trust are undertaking a review of all of its learning difficulty services that they now have responsibility before any long term decisions will be made regarding the appointment of a permanent manager. The Trust is already aware of these concerns from having requested and received internal feedback from the peoples’ families/carers and it is understood they intend to discuss this feedback openly with the relevant Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 33 parties to help alleviate some of the feelings of anxiety surrounding the future of the home. Suitable quality monitoring has continued to take place through this very difficult and challenging time with questionnaires having been sent to gain feedback from the people who use the service (as they are able), carers, and staff to develop and improve service. The home also has regular residents, staff, senior carers, and management meetings. The manager is further arranging a team based “away day” for all the staff to help them look at what improvements can take place to help improve quality in all areas. This will be led by an external facilitator who will be independently seeking the feelings of the staff before the day takes place to ensure that their feeling are taken into account. The manager and staff maintain a safe environment with appropriate and required health and safety checks in place to ensure the peoples’ health and safety. Water regulation is in place and hot surfaces protected. The home’s fire recording was seen as was the home’s accident reporting and these were also in order. The home suffered a flood due to some bad weather earlier this year and following on from this new emergency lighting has since been installed whilst the fire precautions, which were upgraded approximately eighteen months ago, were very effective when the flood happened in alerting the staff to the fact that the home’s electrical systems had been affected. This ensured that the management were able to make the people safe and then get the necessary work repaired. Therefore the continued protection of the people who live at the home was maintained. The Commission were alerted to this incident and the action taken to resolve it. However there is a need to ensure that all details of any incident affecting the well being of any person at the home is forwarded to the Commission so that the Commission can be kept up to date on any such incidents and monitor the way that the home responds to such incidents. Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 34 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 2 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 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 2 x 3 x x 3 2 Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 35 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) and (2) (b) (c) Requirement Timescale for action 23/01/08 2 YA16 13 (7) The care plans, and subsequent reviews should be complied, as far as possible, with the person themselves and or/their family/advocate. The care planning processes within the home must address all individual choices/preferences including sexuality and choice of faith if appropriate/needed. This will ensure that the people who live at the home receive person centred care and support, which has been agreed to and meets their needs. The use of restraint measures, in 23/11/07 this case referring to a fixed table on a person’s chair, must be risk assessed and advise sought as to the extent and use of such restraint from other relevant professionals. This will ensure that the peoples’ health care needs are being met. The management must ensure 23/12/07 that there is an up to date complaints procedure provided in an easy to understand format easily available within the home. DS0000036987.V349400.R01.S.doc Version 5.2 3 YA22 16 (1) (3) Occombe House Page 36 This is so that the people who live at the home at the home who are able to understand pictorial language can know how to complain if they wish to. 4 YA23 20 (1) (a) The Torbay Care Trust must ensure that large amounts of monies, held by the Trust on behalf of the people at the home is put into the named account for each individual person, rather than held collectively. The management must review the staffing levels at the home to ensure that there are sufficient staff on duty at all times to provide the necessary care for the people who live at the home at the home. This refers specifically to ensuring the peoples’ social needs can be met at weekends. This will ensure that the people who live at the home can be provided with the level of care they need to pursue outside interests. The management must ensure that the full details regarding the circumstances of any serious incident or accident are forwarded to the Commission. This is so the Commission can monitor any such events and ensure correct action has been taken which will help to protect the people at the home. A representative from the Care Trust must re-commence monthly required visits to the home. This is to ensure that the management of the home is monitored and ensures that the service being provided is in the best interests of the people who live at the home. DS0000036987.V349400.R01.S.doc 23/12/07 5 YA33 18 (a) 23/12/07 6 YA42 37 (e) 23/11/07 7 YA43 24 (1) (a) (b) and 2 and 3 23/12/07 Occombe House Version 5.2 Page 37 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 YA32 Good Practice Recommendations The management of the home should continue to make National staff training available to allow the home to achieve its target of having 50 percent of the staff working at the home trained to NVQ level 2 in care. The training department of the Torbay Care Trust should make the records of the induction training made available to new members of staff available so such records can be kept on the individual member’s staff file, held within the home. The Torbay Care Trust should consider the appointment of a new permanent, registered manager for the service 2 YA35 4. YA37 Occombe House DS0000036987.V349400.R01.S.doc Version 5.2 Page 38 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.V349400.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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