Inspection on 28/06/05 for Overcliffe House

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Overcliffe House 07/06/06

Overcliffe House 29/11/05

Overcliffe House 06/01/05

Overcliffe House 05/07/04

Overcliffe House 09/03/04

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

CARE HOME ADULTS 18-65 Overcliffe House 30/31 Overcliffe Gravesend Kent DA11 OEH Lead Inspector Elizabeth Baker Unannounced 28 June 2005 15:00 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 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 Stationary 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. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Overcliffe House Address 30/31 Overcliffe Gravesend Kent DA11 OEH 01474 535057 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) National Autistic Society Care Home 12 Category(ies) of Learning Disability (12) registration, with number of places Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Specialist service for people with autism Date of last inspection 6th January 2005 Brief Description of the Service: Overcliffe House is a care home providing personal care for 12 Adults with Autistic Spectrum Disorders (ASD). The National Autistic Society (NAS) operate the service, but Hyde Housing Corporation owns the property. The service was first registered in April 1991. The home comprises two large linked semi-detached houses, situated close to Gravesend town centre. Gravesend has many amenities, including shops, pubs, main post office, banks, places of worship and an adult education centre, all of which are easily accessible. Each house has its own kitchen, lounge, dining areas and basement utility rooms. Bedroom accommodation comprises 12 single bedrooms arranged over two floors. None of the bedrooms have ensuite facilities. The home does not have a passenger or stair lift. The property blends into the surrounding area and there is nothing to suggest it is anything other than a family house. There are gardens at the rear of the property and parking is available at the front. In addition to the residential accommodation the NAS provides day care activities in a variety of locations in the Gravesend area for residents from this home, as well as from the community and two other associated care homes. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of the premises took place over 3½ hours. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. A number of residents and practitioners were spoken with. Some judgements about the quality of care, life and choices were taken from direct observation, speaking with residents and staff and available records. Ms C Jerram, the newly appointed Manager, assisted with the inspection process. Additional records were inspected at the Provider’s Gravesend area office on the 29 June 2005. Some records were seen as part of case tracking and to assess work on requirements and recommendations made at previous inspections. What the service does well: What has improved since the last inspection? What they could do better: Residents care records are still not maintained in such a way so as to provide practitioners and others delivering care and support with enough precise details. Also the practice of keeping numerous care records in various places around the home prevents a clear and current picture of residents’ condition and precise medicine requirements being easily available. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 6 Practitioners do not keep all information about residents appropriately, thereby jeopardising their confidentiality and security. There are still no facilities for practitioners to wash their hands in residents’ bedrooms in the event of personal care assistance being required. This poses a serious infection control risk to both residents and practitioners. Improved facilities for washing soiled and or infected linen must be introduced to minimise potential risks to residents and practitioners. To improve infection control practices and awareness, practitioners must familiarise themselves with the contents of the Kent and Medway Community Infection Control guidelines, a copy of which was provided to the home at a previous inspection. 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. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/I There have been no new admissions into the home since 1995. Therefore no judgement has been made on these standards at this visit. EVIDENCE: Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9, and 10 Residents cannot be sure their personal goals are reflected in the individual plans and their potential risks managed. Residents’ records are not appropriately maintained and kept securely to maximise confidentiality. EVIDENCE: For case tracking purposes, care records of two residents were inspected. A resident whose psychological behaviour has deteriorated is being regularly assessed by hospital clinicians. Details of this had not been adequately recorded in his actual care plan, although reference to this was found in another of his care record books. The resident requires antipsychotic medication. There were three conflicting references to this medication, with particular regard to the current dose being administered. This situation poses a potential risk to the resident. Residents are assessed as to their suitability to go out and about alone. The current method of record keeping made it difficult to establish whether the risk assessment for a resident who is currently subject to “free time” limitations due to an incident, had been reviewed because of the current method of record keeping. Details of the limitations had been publicly displayed at the home, thereby compromising the resident’s confidentiality. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 10 Details of residents’ care needs are recorded in a number of different books. One record book described activities and occurrences having taken place on the 29 June 2005. The inspection took place on the 28 June 2005. Accurate dated records must be maintained to evidence actual care provided. Residents are involved in their annual reviews. However the records inspected did not contain evidence that the residents had been invited to sign the plans as to their agreement and understanding of the content. Although some records contained good information, overall little progress has been made on previous recommendations to ensure social and personal goals are broken down into discrete skills/knowledge that residents may need to be taught or developed to achieve their ultimate goals. Discussion with the new manager suggested that some needs were being addressed even though there was a lack of clear plans and guidance. This approach is dependent on practitioners’ memory and good verbal communications. However residents are at risk at not having their health, psychological and social needs met if these informal systems break down. When assisting residents with financial transactions, practitioners sign the resident’s individual expenses sheets. Sadly residents are not invited to add their signature as part of the process. The expenses sheets as well as bank account statements are kept in the main care records file. This practice could compromise residents’ financial security. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Links with the community are good and support and enrich residents’ social and educational opportunities. EVIDENCE: Residents spend their weekdays attending day centres operated by the National Autistic Society. These centres provide a vast range of activities including art workshops, computing, life skills, woodwork and gardening. One resident described how he enjoys art classes and also attends the nearby Victoria Centre so he can do more artwork. Residents spoke enthusiastically about their holidays, which they take with other residents and members of staff. These have included Spain, France, Jersey and Wales. One resident said he is looking forward to going to Portugal in September. Residents are able to make regular home visits, although this arrangement is not available to all residents because of family situations. Where this not possible, practitioners endeavour to provide the residents with more one to one time, to ensure residents do not feel left out. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 12 Residents continue to develop their life skills by participating in the running of the home. This includes doing their own laundry, shopping, cleaning their bedrooms and doing their ironing. Residents are also involved in menu planning and meal preparation, with support from practitioners where this is required. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The health needs of residents are met with evidence of good multi disciplinary working taking place. Medication records are poor and potentially place residents at risk. EVIDENCE: Residents receive input from specialist clinicians where their assessed needs require this. In-house treatments are carried out in their bedrooms to maximise their privacy. Practitioners assist residents in attending hospital and GP appointments, where this is required. Residents are supported with their medications and practitioner’s complete charts as evidence of administration. A particular resident has been prescribed regular dose antipsychotic medication. However the medication administration record chart dose instructions conflicted with other associated care records currently in use referring to this medication. Maintaining various records with regard to doses and frequency of prescribed medications is confusing and potentially dangerous to residents. Another chart contained handwritten transcription entries. The entries had not been signed by the transcriber to ensure a clear audit could be undertaken. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 14 A book to record drug incident and errors has not yet been started, although this was a recommendation made at the last visit. The new manager is aware of the advantages of maintaining such records, and will be implementing a system shortly. This system will enable the manager to monitor trends and take any necessary action, including re-training, where this is required. Two lockable cupboards have been obtained for storing medications. However the design, security and siting of the current facilities do not maximise safety for residents and staff. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents are at risk because of incorrect recording of complaints and the manager’s lack of knowledge and experience with regard to the County’s adult protection procedures. EVIDENCE: Following a recommendation made at the last inspection, a book is now kept to record “low level” complaints. So far the book has been used by practitioners to record maintenance issues, despite the availability of separate maintenance logs for this purpose. This situation does not assist the manager in monitoring trends or the maintenance staff having ready access to what is required of them. The new manager is not aware of the County’s adult protection procedures. Although the manager described what she would do if she had a suspicion or evidence of adult abuse, residents are vulnerable in that adult protection procedures may not be initiated, as required. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27 and 30 Residents live in a homely environment but are risk because of poor infection control facilities and practices. EVIDENCE: All bedrooms are for single occupation and have been personalised and furnished to suit residents’ individual preferences. Residents are involved in decisions affecting the redecoration of their rooms. Areas inspected were clean and odour free. The home has two separate basement laundry rooms. The manager confirmed that Hyde Housing, owners of the property, has agreed to re-seal and repaint the laundry walls in number 30, which will improve the environment as well as allowing for more effective cleaning. One of the residents has a behaviour problem, which occasionally results in them being incontinent of urine. There are no water-soluble or alginate bags in which soiled clothes and or linen can be safely washed. This situation is potentially hazardous to both residents and staff. Dirty linen is also placed directly on the laundry floor. Although the floor is swept clean, it is not the home’s practice to thoroughly wash the floors. Both situations pose serious infection control risks to both residents and staff. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 17 Residents’ bedrooms do not have wash hand basins. In 2004 specialist advice was sought and provided by Dr Chandrakumar, Clinical Director of Kent and Medway Health Protection Unit on how infection control practices can be maximised if residents required assistance with their personal care in their bedrooms. To date the specialist advice has not been adhered to. The situation poses a serious risk to both residents and practitioners and must be addressed. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34 and 35 Progress has been made in the standard of vetting and recruitment practices, but further action is still required to ensure residents are not put at risk. Staff are multi skilled ensuring continuity of care and support. EVIDENCE: The provider continues to demonstrate its commitment to ensuring all practitioners are trained to NVQ level II, with over 50 of the workforce at this home now having attained this qualification. In addition to NVQ training, practitioners are required to undertake training to meet the care needs of the residents with autism. This training includes Structure, Positive, Empathy, Low Arousal and Links (SPELL) and Treatment and Education of Autistic and related Communication-handicapped children (TEACH). Practitioners were seen carrying out their duties in unhurried manner, despite a disruptive incident taking place during the visit. Systems are in place for the recruitment and appointment of staff. The three files inspected at the Gravesend Area Office of the most recently employed practitioners contained the necessary documents to demonstrate appropriate procedures are in place. However there was no recorded evidence that a tenyear employment gap had been explored for one particular applicant. To Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 19 ensure residents at not placed at risk, all employment gaps must be explored and the findings recorded. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42 The new manager has a good understanding of what needs to be done to improve the home and practices. Management of the home is satisfactory overall but records are not well managed. This practice could place residents at risk. EVIDENCE: The new manager was appointed in March 2005. The manager is a qualified assessor but is not a qualified manager. The organisation is arranging for the manager to access relevant courses in order for her to attain the requisite care and management qualifications required for this post. During the inspection the manager was receptive to advice given and demonstrated an eagerness to ensure the home’s practices and systems are improved. This will ensure residents are safely cared for. The manager is currently reviewing the home’s fire risk assessment, with assistance from the area’s health and safety risk assessor. The manager said Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 21 bath hot water temperatures are controlled to prevent residents scolding themselves. Practitioners receive core training including heath and safety. However comments contained in the “low level” complaints book referred to practitioners opening one of the washing machine doors with a knife. Residents also use the machine to wash their own clothes and linen. Opening the machine door in this way is hazardous to both residents and staff and must cease. To ensure all reportable incidents are notified to the Commission as required by Regulation 37, the new manager was provided with a copy of the Commission’s current policy guidance, for her information. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 x x 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Overcliffe House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 23 Yes 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. 2. 3. 4. Standard YA20 YA20 YA20 YA20 Regulation 13(2) 13(2) 13(2) 13(2) Requirement A drug incident/error book must be maintained. Timescale of 31/01/05 not met. A policy for leave medicines which covers record keep. This was not discussed. Details of regular dose medication must be accurately maintained. Handwritten transcriptions entries on medication administration record charts must be signed by the transcriber. The newly appointed manager must receive appropriate training in respect of the countys adult protection reporting procedures and protocols. Employment history gaps must be explored and the findings recorded. Timescale of 31 January 2005 not met. Appropriate fire risk assessment must be completed as per the Fire Services requirements. The requirements of the Clinical Director of Kent and Medway Health Protection Unit must be adhered to with regard to the provision of handwashing Timescale for action 31/07/05 31/07/05 28/06/05 28/06/05 5. YA23 13(6) 31/08/05 6. YA34 19 29/06/05 7. 8. YA24 YA26 23(4) 16(2)(j) 30/09/05 31/08/05 Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 24 facilities for staff. 9. YA30 13(3) The laundry flooring must be of a 30/09/05 type which can be effectively washed. Soiled and infected personal clothes/linen must be appropriately handled and washed. Knives must not be used to open 28/06/05 washing machine doors. Medicine storage facilities must 31/08/05 be of a type that maximises security and safety and are appropriately sited. 10. 11. YA42 YA20 13(4) 13(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA7 YA9 YA10 YA22 YA37 Good Practice Recommendations Care plans must promote the recording of comprehensive details of the setting and recording of discrete goals to reflect residents skills, knowledge and abilities. Residents should be invited to sign or initial records of financial transactions made on their behalf. Full details of any limitations imposed on residents must be included in their respective care plan and be easily accessible for review. Financial and personal information in respect of residents must be appropriately stored for security and confidentiality purposes. Practitioners should ensure complaints books are appropriately used. The newly appointed manager must be registered by 30 June 2005 on an appropriate Registered Manager course in order to successfully complete the requisite qualifications in both management and care within two years. Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 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 Overcliffe House H56-H06 S23991 Overcliffe House V233125 280605 Stage 4.doc Version 1.30 Page 26 - 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. 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