Inspection on 01/07/05 for Paddock House

This inspection was carried out on 1st July 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 but made no statutory requirements on the home.

Other inspections for this house

Paddock House 25/03/08

Paddock House 28/11/07

Paddock House 06/07/06

Paddock House 27/01/06

Paddock House 27/01/05

Paddock House 08/09/04

Paddock House 20/03/04

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

CARE HOME ADULTS 18-65 Paddock House 13 Prospect Road Hythe Kent CT21 5NN Lead Inspector Julian Graham Unannounced 1 July 2005 10:00 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. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Paddock House Address 13 Prospect Road, Hythe, Kent, CT21 5NN 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) (01303) 230067 Mr James Peter McCarthy Mr James Peter McCarthy Care Home only 16 Category(ies) of Mental Disroder x 16 registration, with number of places Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27/1/05 Brief Description of the Service: Paddock House is registered to provide accommodation and personal care to 16 adults with a mental health disorder (excluding learning disability and dementia), and is owned and managed by Mr Jamie McCarthy.Paddock House occupies detached premises with sixteen single bedrooms, one of which having ensuite facilities. Accommodation for Residents is on two floors. The frontage of the home opens onto a public pavement, but there is a small garden and seating area at the rear for Residents to use. There are bathing and shower facilities on both floors in addition to a number of toilets throughout the premises. The home is situated centrally in a small costal town, with good access to local shops, pubs, clubs, library, swimming pool and public transport. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 10.00 and took place over six and a quarter hours. Nine residents were spoken to during the visit. He also spoke with the manager briefly, the deputy manager, a volunteer who undertakes much of the administrative and managerial tasks, and three of the care staff, two of whom individually and in private. A Community Psychiatric Nurse was visiting the home who spoke positively about the home. A tour of the premises was undertaken, and some records were examined, including care plans, incident reports and a staff file. Lunch was shared with the residents. What the service does well: What has improved since the last inspection? What they could do better: Whilst staff were able to demonstrate safe systems of administering medication to residents, some medicines were seen on the day of inspection as not being safely stored. Immediate action was taken by the deputy manager to ensure that all medicines were locked in the medication cabinet. Some other Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 6 shortfalls in respect of medication were noted and must receive prompt attention. Owing to the behaviours of one of the residents, the home’s open door policy of enabling residents to enter and leave the premises freely has recently been changed. The front door is now locked and residents need to ask staff to unlock the door when they want to go out and come back in. This effectively amounts to restraining residents. The home is actively working with health care professionals to address the behaviour of the resident which necessitated the action in the first place. The home is aware that this situation can only be of a temporary duration, and that the former policy of free access to and from the premises is reinstated at the earliest opportunity. 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. Paddock House H56-H05 S23503 Paddock House V233073 010705 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 Paddock House H56-H05 S23503 Paddock House V233073 010705 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) 2,4 The arrangements for admitting people into the home are good, with assurance provided to prospective residents that their care needs can be met. EVIDENCE: The Volunteer outlined the procedure for assessing the suitability of prospective residents to move in to Paddock House, and the files of the two most recently admitted residents were examined. Pre-admission assessment information and a care plan is provided by the funding authority, and meetings are arranged with the prospective residents and their social workers to discuss the application and any relevant issues, including the person’s background and history wherever possible. The prospective resident has the opportunity to spend time in the home to meet staff and residents, and the home completes its own pre-admission form. Issues of compatibility are explored, and the inspector was advised of the applications of two prospective residents being turned down recently, because the home could not meet the persons’ needs. If accepted, residents have a minimum six month settling in period. Paddock House H56-H05 S23503 Paddock House V233073 010705 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) 6,7,8,9 Staff treat residents with kindness and respect. Care planning has improved, and residents are consulted as much as possible regarding aspects of life in the home. EVIDENCE: A sample of care plans were viewed on this occasion, and as required from previous inspections, the mental health needs of the individual residents are featured within the care plans. Files were well ordered with information generally easy to locate. The degree of support needed to meet needs was also detailed, for example, encouragement to change clothes. There was clear evidence that the care plans are reviewed every three months with involvement from the residents. Risk assessments are in place as appropriate. One resident has received a lot of support from the activities co-ordinator in making the decision to move back to her flat, and in having the confidence to do so. Residents are encouraged to attend monthly house meetings, although the level of interest, the inspector was told, is low. Opportunities to give and receive information are given in these meetings, the minutes of the most recent one, for example, advising residents of recent staff and resident changes. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 10 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) 12,13,14,15,16,17 Relationships between staff and residents are good. Encouragement and support are given to residents to participate in leisure activities and household tasks. Routines are generally flexible and respectful of residents’ wishes. The recent locking of the front door, however, is restrictive of residents’ freedom of movement. EVIDENCE: The inspector saw staff interact positively with residents, with all of whom spoken to saying they like the staff and find them helpful. The inspector noted a staff member knocking on a resident’s door and awaiting an answer before entering. One resident said “staff ask my permission before going into my room.” The home employs a staff member with a specific remit to support residents in undertaking social and leisure activities. A resident, on the day of inspection, for example, was out with this staff member bird watching. Other activities include being supported in attending a pottery class, going into town for a coffee, and horse riding. Local clubs and facilities, such as the MIND and umbrella clubs are attended by one or two residents, and one resident is an active member of a local church. Residents told the inspector that their friends and family are made welcome when they visit. Routines are generally very Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 11 flexible, and with one recent exception, residents said that their freedom of movement is respected by staff. As referred to in the summary of this report, the front door is now being locked, with residents needing to ask staff to unlock the door for them when they want to go out and come in. This is because one resident may be at risk should he go out unescorted. Two residents told the inspector that they find this arrangement difficult. The home is aware that this arrangement amounts to restraint and must only be for a time limited period for alternative strategies to be agreed with the resident and his CPN and social worker. The inspector has set a short timescale for the resolution of this matter. The written policy on restraint needs amending. All the residents spoken with said they enjoy the food, and that they do have choices. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 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 standard(s) 18,19,20 Residents’ healthcare and social and emotional needs are being met. The systems for medication administration are generally sound, although there is a major shortfall in respect of storage. EVIDENCE: Residents are given support to access healthcare facilities themselves where this is appropriate. The CPN visiting the home at the time of inspection, said that the home will always contact the community psychiatric nursing service when the need arises. Contacts with healthcare professionals are recorded in individual files. Care plans referred to the need for support in the area of personal hygiene where this was relevant. With regards to medication, two staff members outlined a sound procedure for the administration of medication and the MAR charts were generally in order. However, unsafe practice was noted in respect of medication storage, with a number of liquid and other medicines, including depot injections, being found unsecured on an open shelf alongside the medication cabinet. An Immediate Requirement was made to rectify this potentially dangerous practice, and precipitate action was taken straightaway to ensure these medicines were safely stored. Other shortfalls included some overstocking, some medicines which were not blister packed were not being kept in their original boxes, and handwritten entries in MAR charts are still not being signed, checked and countersigned. The medication policy still needs to include policies on homely and covert medication. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 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 standard(s) Not inspected EVIDENCE: Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 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 standard(s) 24,26,27,28,30 The standard of the décor within the home is satisfactory with evidence of improvement. EVIDENCE: The downstairs bathroom and toilet have been upgraded since the last inspection, and now have a more homely and less institutional feel to them. An old wooden chair in one of the bathrooms needs replacing. The smoking room has also been redecorated with a new extractor fitted. Audits of bedrooms are undertaken from time to time, with residents asked whether they are satisfied with their rooms and whether they are in need of any furniture or equipment. The minutes of a recent Residents’ Meeting referred to residents being asked whether they would like their room decorated. A small number of rooms were viewed on this occasion, and these were satisfactory. One of the vacant rooms had a chair that looked old and rather grubby, and this will need replacing. Lockable facilities in bedrooms have recently been renewed. The premises was clean and at a comfortable temperature at the time of inspection. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35 Staff morale is good resulting in little staff turnover. Recruitment policies are being consistently followed ensuring the appropriate vetting of staff. Staff have a good understanding of residents’ needs. EVIDENCE: Most of the staff have been working in the home for some time now and positive relationships have developed between staff and residents. This consistency and continuity of care is of benefit to the residents who know that staff have knowledge of their needs. According to the staff rotas, sufficient numbers of staff are on duty each day to support residents. The file of a recently appointed staff member was viewed, and sound recruitment practice was seen. The application form section regarding the Rehabilitation of Offenders Act, must be amended, however, to ensure that prospective staff do not withhold information regarding “spent” convictions. A comprehensive staff induction programme is being followed which includes the watching of videos on schizophrenia, anxiety and obsessive compulsive behaviours. Little in the way of staff training has been undertaken in 2005. However, the plan of the staff training and development programme for 2005-2007 was seen, with a budget of £5,000 available. This incorporates a twelve week distance learning training programme on a range of topics, including communication and fire awareness. Two care staff were interviewed individually and presented well. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 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 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) 38,39,42 The manager is supported well by the senior staff in the home, with staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager continues to delegate much of the management functions of the home to the deputy manager and the volunteer. As recommended in previous reports, the manager is starting to attend more staff and residents’ meetings. Notwithstanding the matter relating to locking the front door, there is a friendly, open and welcoming atmosphere at Paddock House, where efforts are made to consult residents on their views of the home, and where they want improvements to be made, through feedback questionnaires and meetings with residents. Several residents told the inspector that staff are “approachable and friendly”. Equipment and appliances are being serviced at regular intervals, and documentation was seen in support of this. A fire risk assessment was undertaken in June 2005, and this has been sent to the fire authority for checking. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 17 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 3 x 3 x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 2 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Paddock House Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x x 3 x H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 18 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. Standard 16 20 Regulation 12 13 Requirement The front door must be kept unlocked to allow residents freedom of movement. With regards to medication: a) all medication must be kept securely in a locked cabinet at all times. b) medicines which are not blister packed must be kept in their original boxes. c) medicines must only be ordered when actually needed. d) handwritten entries on MAR charts to be signed, checked and countersigned. e) medication policy to include policies on covert and homely medication. (timescale of 27/02/05 not met) Paper towels to be available in the laundry. Staff application form to require prospective applicants to detail all convictions, including those which are spent. Policy on restraint to be amended. Timescale for action 14/07/05 a) 01/07/05, b) 01/07/05, c) 01/07/05, d) 01/07/05, e) 21/07/05 3. 4. 30 34 13 19 14/07/05 01/07/05 5. 40 13 21/07/05 Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 19 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 26 Good Practice Recommendations Wooden chair in bathroom to be replaced. Paddock House H56-H05 S23503 Paddock House V233073 010705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford, Kent TN23 1HU 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. 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