CARE HOME ADULTS 18-65
Overcliffe House 30/31 Overcliffe Gravesend Kent DA11 0EH Lead Inspector
Elizabeth Baker Announced Inspection 29th November 2005 09:30 Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Overcliffe House Address 30/31 Overcliffe Gravesend Kent DA11 0EH 01474 535057 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) National Autistic Society Carolyn Jerram Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Specialist service for people with autism Date of last inspection 28th June 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 it 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 NAS provides workshop 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 homes. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place on the 29 November 2005 and lasted just under four hours. A partial tour of both houses took place. At the time of the inspection the twelve residents were in the process of going to their respective workshops and garden nursery. In preparation of the inspection a visit was made to three of the NAS workshops, including the Robbie Centre, Artrack Centre and Sands on the 25 November 2005. Three residents from Overcliffe House were spoken with at the Artrack Centre and a number of others at the Sands Centre. Members of staff were also spoken with at the workshops. Some judgements about the quality of care, life and choices were taken from conversations with residents and staff, as well as direct and indirect observations. Some records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspection. In response to the announcement of this inspection the Commission received a total of 31 comment cards from Residents (11), Relatives/Visitors (11), Care Managers (6), Health and Social Care Professionals (2) and one GP. Some of their comments have been incorporated into this report. This is the second inspection of this home for the year 2005/06. Not all key standards have been inspected on this occasion, where they were met at the first visit. This report should therefore be read in conjunction with the inspection report dated 28 June 2005. What the service does well:
Although lifestyle standards were not re inspected on this occasion, the visit to three workshops on 25 November 2005 identified that residents receive structured activities to maximise their potential and to reflect their individual skills and talents. Indeed a replica Wurlitzer, which has been made by residents from this and the other two houses, takes pride of place in the refurbished diner in one of the day centres. Residents were seen engaged in making handmade seasonal decorations and greeting cards. Three residents observed at the Artrack workshop were busy with their craft and woodwork activities. Many of the home’s residents seen at the Sands Centre were getting ready to go to their swimming sessions at a nearby leisure centre and indicated they enjoyed this. Comment card respondents’ additional remarks included “My [relative] is cared for very well at all times”; I am very satisfied with my [relative’s] care”, “I am impressed by the care my [relative] receives at Overcliffe House and the staff are kind and helpful”; “A lovely well run house generally”; “I’m very pleased with the care and support my [relative] receives. [They] are treated with respect and dignity. I would like a little more information setting out names of staff and their roles”; “I am very happy the staff show the way they care for
Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 6 my [relative]. No complaints at all”; “The staff are in regular contact. Excellent, superb service”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 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 the following standard(s): N/I There have been no new admissions into the home since 1995. Therefore no judgement has been made on these standards. EVIDENCE: Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 9 and 10 The health needs of residents are met with evidence of multi disciplinary working taking place when required. EVIDENCE: For case tracking purposes, three care records were inspected. A resident currently experiencing eating problems is having their weight monitored weekly. Details of this current problem are recorded. However references to the meals actually provided and the amount the resident consumes varies in content depending on the practitioner completing the records. The records indicate the resident is experiencing pain. However the site of the pain was not recorded, although this is known to staff. The manager said body maps are being re-introduced which will be used to record the sites and monitor the pain. A “PRN” medication has been prescribed. The care plan did not contain the actual administration details of this medication, although details were noted in other records. Residents are appropriately supported in accessing health screening checks. However the records of a particular resident were not reflective of the action currently being taken as described during the inspection. The three files contained summaries of life long learning goals. It is the manager’s intention to develop the care plans further to ensure they
Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 10 contain the discrete details of skills and knowledge residents need to know or to develop to reach their ultimate goals. Comment cards received from two hospital consultants and a GP indicated their patients are appropriately cared for. To aid residents’ communication, picture prompts and sign details covering numerous matters are readily available for residents to access. This should ensure residents are better informed when making choices. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 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 the following standard(s): N/I These standards were inspected and met at the last visit. They have not been reassessed. EVIDENCE: Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 and 21 Records of medication administration have improved ensuring residents’ safety. EVIDENCE: The review of medication administration record charts indicated handwritten transcription entries had been signed by the transcriber (practitioner) and countersigned by another practitioner. However the charts did not contain details of the prescriber initiating the changes, although details were recorded on other forms. Since the last inspection secure facilities have been acquired for the storage of medications. However the facilities are sited near radiators, which at the time of the visit were hot. In order that medicines are stored in accordance with manufacturers’ instructions with regard to temperatures, it was recommended that the a thermometer be used to monitor the ambient temperature. Following a recommendation made at the last visit a drug error/incident book has been introduced. This is good practice and allows for easier auditing of this care aspect. The three care records did not contain sufficient detail in respect of residents’ wishes in respect of death and dying. Whilst acknowledging that the majority of residents are young, this is an important aspect of care and needs to be addressed.
Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Some residents may not be convinced their complaints and or concerns are properly dealt with. EVIDENCE: During discussions it transpired a resident had recently made a verbal complaint. Although the home has a complaints book this complaint had not been recorded. The manager is aware of action to be taken if there was a suspicion of abuse. Since the last inspection the home has acquired the County’s adult protection procedures. The manager anticipates attending appropriate adult protection training in the New Year, as part of the additional training the Organisation is requiring of all their managers. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 The home’s environment has improved enhancing residents’ quality of life. EVIDENCE: Bedrooms and other areas of the home inspected were clean, tidy, warm and odour free. Indeed a resident said their room is nice and warm. Since the last inspection one TV lounge has been recarpeted and redecorated. New sofas have been ordered and staff hope they will be delivered before Christmas. One of the two basement laundries has new flooring and the walls have been re-plastered. This provides a safer environment for residents and staff when doing their washing. Hand-wash gel products have been purchased. This will assist practitioners in maintaining good hygiene practises when supporting residents with personal care, particularly in those bedrooms, which do not have hand basins. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 Staff turnover is low ensuring residents receive consistent care and support. EVIDENCE: There have been no external appointments since the last inspection visit. Following a requirement made at the last inspection, the manager reported that the ten-year employment gap previously identified had been investigated and details recorded in the file. The manager said she is responsible for supervising practitioners and formally supervises them regularly. This supervision is supplemented by annual appraisals, this is good practice. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 The new manager is enthusiastic about her role and is striving to improve the home for the benefit of residents. EVIDENCE: The manager has enrolled on a Registered Manager course. In addition to this course, the organisation is requiring all home managers, trained or untrained, to undertake supplementary training relevant to their roles and responsibilities. Almost fifty percent of practitioners are now trained to NVQ level II. This demonstrates the organisation’s commitment to ensuring their staff are appropriately qualified. As part of the home’s training programme, staff are required to watch fire safety videos and complete questionnaires. Residents are also involved in this practice and are encouraged to question staff about fire safety matters. For a resident who is deaf, a special warning light has been installed in their bedroom for fire safety purposes. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 17 The manager is currently liaising with the local Fire Brigade in respect of the home’s fire risk assessment. Fire safety records are maintained. Having appropriate systems and documentation available reduces fire safety risks to residents and staff. The pre inspection questionnaire records 11 practitioners are trained in first aid. The manager said four practitioners are qualified first-aiders. Residents with support from practitioners do their own washing. Both laundry rooms are situated in the basement and have to be accessed externally. It was noted on this visit that the handrail to the laundry room in number 30 does not extend to the to the top of the stairs. This situation is potentially hazardous to both residents and staff. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Overcliffe House Score X X 2 2 Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 X DS0000023991.V256173.R01.S.doc Version 5.0 Page 19 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 YA23 Regulation 13(6) Requirement Timescale for action 2 YA42 23(4) 3 YA42 13(4) The newly appointed manager must receive appropriate training in respect of the County’s adult 31/03/06 protection reporting procedures and protocols. (Provider’s timescale 31/10/05 not completely met) Appropriate risk assessment must be completed as per the Fire Service’s requirements. 31/03/06 (Almost met. Home and Fire Brigade still in correspondence) The handrail to the basement 31/03/06 laundry room on number 30 must be extended or replaced. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA6 Good Practice Recommendations Practitioners should keep precise details of residents’ meals and quantities provided and consumed when identified as a problem. Care plans must contain administration details of
DS0000023991.V256173.R01.S.doc Version 5.0 Page 20 Overcliffe House 3 4 5 6 7 8 YA6 YA20 YA20 YA21 YA22 YA37 ‘administer when required’ (PRN) medications. Care plans must include details of the setting and recording of discrete goals to reflect residents’ skills, knowledge and abilities. Medication administration record charts must state the name of the prescriber authorising medication administration changes. Medications must be stored as per manufacturer’s instructions with regard to temperatures. Details of residents’ preferences in respect of death, dying and last rites must be obtained and recorded in their care records. All types of residents’ complaints must be recorded The registered manager must successfully attain the requisite management and care qualifications within two years. Overcliffe House DS0000023991.V256173.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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