Inspection on 27/01/06 for Paddock House

This inspection was carried out on 27th January 2006.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Paddock House 25/03/08

Paddock House 28/11/07

Paddock House 06/07/06

Paddock House 01/07/05

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 Paddock House 13 Prospect Road Hythe Kent CT21 5NN Lead Inspector Julian Graham Unannounced Inspection 09:40 27 January 2006 th Paddock House DS0000023503.V265336.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 Paddock House DS0000023503.V265336.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. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Paddock House Address Paddock House 13 Prospect Road Hythe Kent CT21 5NN 01303 230067 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) Mr James Peter McCarthy Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st July 2005 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 DS0000023503.V265336.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 09.40 and lasted around four hours. Thirteen residents were at home at the time of the visit, and eight were spoken with individually. The majority of the time was spent talking with residents, including having lunch with them. Time was also spent in discussion with the manager and a volunteer, who undertakes much of the administrative and managerial tasks, in looking at some paperwork. Parts of the premises were viewed, and one of the care staff was interviewed privately. The deputy manager, activities co-ordinator and housekeeper were also spoken with, and also a visiting Community Psychiatric Nurse. Comments from residents included: “ I like the staff here, they treat me well”; “I have enough to eat”; “they (staff) ask me for my views sometimes”; “I can go out when I like”; “everything’s fine.” What the service does well: What has improved since the last inspection? The arrangements for storing medication safely have improved. A new cupboard is in place, and medicines, which are not blister packed, are being kept in their original boxes. There is now no overstocking of medication, and handwritten entries on MAR charts are being signed and checked by two staff to minimise the risk of errors. A policy on homely medicines is in place. For the protection of residents, the staff application form now requires prospective applicants to detail all convictions, including those which are “spent”. Some improvements to the environment have taken place, including a new three-piece suite for the lounge, repainting of the staircase, new chairs in the Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 6 smoking room, one of the bedrooms and a bathroom. Paper towels are now available in the laundry. Care plans are continuing to improve. 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. Paddock House DS0000023503.V265336.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 Paddock House DS0000023503.V265336.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): Not inspected on this occasion. The previous inspection noted that the arrangements for admitting new residents were good. EVIDENCE: Paddock House DS0000023503.V265336.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): 6,7,8,9, Care planning continues to improve, and residents are being supported to take risks as part of an independent lifestyle. Residents are encouraged to make decisions, and are consulted as much as possible regarding aspects of life in the home. The staff key-working role could be better understood and more effectively carried out. EVIDENCE: A small sample of care plans were viewed and these address residents’ daily care needs in addition to their mental health needs. Risks are being identified and written assessments are in place, which are being regularly reviewed. Each resident has a key worker who has the responsibility of monitoring individual needs, and there are good written guidelines to assist staff in this role. It was not clear that staff are effectively understanding or carrying out their key working role as effectively as they could. It is a recommendation of this report that some in-house training is undertaken to increase awareness of the role; and for regular meetings with their key residents to be introduced, and which are recorded, to discuss the care they are receiving and how the home is assisting them in meeting their needs and achieving their goals. Residents said that staff support them in making decisions. Where freedom of movement or choice is being restricted in the persons’ best interest, records Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 10 are in place in support of this, with evidence of consultation with relevant parties, including the person’s Social Worker or CPN. Paddock House DS0000023503.V265336.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): 11,13,14 There are good relationships between residents and staff. Independence is encouraged, subject to risk assessment, and residents are being enabled to be part of the local community. There are good opportunities for residents to take part in social and leisure activities. EVIDENCE: There is a variety of activities available for residents who need the assistance of staff to participate. The home is continuing to employ an activities coordinator with a specific remit to support residents in making use of community facilities, and in the undertaking of social and leisure activities. A resident was accompanied to the shops on the day of inspection, for example. One resident said that with support she helps out in the kitchen and assists in the cooking of meals from time to time. A lot of the residents are able to go out on their own, and maintaining this level of independence is encouraged by staff. Some residents are needing assistance to develop and maintain other daily living skills, and a staff member gave an example of a resident who is beginning to need less support from staff in keeping her room clean. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 12 The previous inspection report referred to the front door being locked, with residents needing to ask staff to unlock the door for them when they wanted to go out. This was to protect one resident who would be at risk if he was to go out unaccompanied. Since then, a keypad has been installed, and the home was able to provide evidence that residents able to go out unaccompanied have no problem with this arrangement and can operate the keypad independently. There are two residents who now need staff support when going out, and there is documentation in these persons’ files from their Social Workers confirming that they need this level of support, and would be at risk in the community without it. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 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 the following standard(s): 20 The arrangements for the safe storage of medication have improved. EVIDENCE: Since the last inspection, a new cupboard for medication has been provided, and medicines were seen to be stored safely and appropriately within it. MAR charts were in order, with no gaps in administration seen, and with handwritten entries checked and signed by two staff. There was no evidence of overstocking on this occasion. The staff member who was interviewed privately, outlined a sound procedure for the administration of medication. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 14 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): 22,23 The complaints process in the home is satisfactory. Residents are protected from harm and neglect, although staff would benefit from training in abuse issues. Clearer records of monies held by the home on behalf of residents are needed. EVIDENCE: The complaints procedure is displayed prominently in the home, and the minutes of a recent residents’ meeting noted that residents were reminded of their rights to comment and complain about the care and service they are receiving. Residents spoken with said, in the main, that they would feel able to complain in the confidence that staff would listen to them. One resident said he does not like to complain, but at the present time has no nothing he wants to complain about. No complaints have been recorded since the last inspection. The home has adult abuse and whistle blowing policies in place, and the staff member interviewed knew the action to take in the event of an allegation or suspicion of abuse. Staff would benefit from a training course on abuse however, to increase their awareness and knowledge, and this is a requirement of this report. The home is holding monies on behalf of three residents, and the way financial transactions are being recorded needs to improve. Records viewed did not indicate what the current balance should be and were difficult to audit. A clear auditable record of monies must be maintained, including a current and accurate balance. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 15 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, 27,28,30 The premises is looking rather shabby and run down in places. Improvements to the environment will enhance the residents’ quality of life. EVIDENCE: A tour of the premises revealed, that whilst some improvements have taken place since the last visit, some parts of the home are in need of redecorating and freshening up. The home has recognised this, and has prepared an action plan, dated 01/01/06, identifying areas needing attention, with a timescale of eight months to achieve the upgrading. All parts of the home were clean and hygienic. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 16 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): 31,32,33,34,35,36 Residents benefit from a well-motivated and committed staff team, who are being well supported. Recruitment practice is generally sound. EVIDENCE: A high level of morale was noted, and staff turnover remains at a low level. Staff on duty demonstrated competence and a kindly and respectful approach to their work. Residents said they like the staff and find them helpful. A new member of staff has started NVQ Level 2 training, and another has commenced NVQ Level 3. A third staff member is to start Level 3 training shortly. The home’s training plan shows that training on First Aid, personal development, medication, and fire safety have been prioritised for completion over the next few months. Staff rotas show a sufficient level of staffing in place to meet the needs of residents. Two staff have been recruited since the last inspection, and records show that the required checks are being made to ensure the protection of residents. A checklist noting when references, CRB checks and so on are applied for and returned would help keep effective track of the process, and is recommended in this report. Staff confirmed they are receiving support in their work and are being regularly supervised. Paddock House DS0000023503.V265336.R01.S.doc Version 5.0 Page 17 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): 37,38,39,42 The manager is supported well by the senior staff, and residents are benefiting from the ethos of the home. EVIDENCE: The manager now has a number of years experience as manager of the home, although does not indicate a willingness to undertake the RMA training. He is being given good support from the deputy manager and a volunteer, who undertakes much of the management and administrative functions. A friendly, open and welcoming atmosphere was again noted at Paddock House. The home makes every effort to seek residents’ views, through six monthly feedback questionnaires and two monthly residents’ meetings. The findings from the latest questionnaires were posted on the residents’ notice board, and a high level of satisfaction was noted. Some documents relating to the servicing of appliances and equipment were examined, including the fire alarm and emergency lighting system, gas and electrical installations and portable electrical appliances. These were all in date. No obvious health and safety hazards were seen on this visit. Paddock House DS0000023503.V265336.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 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 2 2 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Paddock House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 3 x x 3 x DS0000023503.V265336.R01.S.doc Version 5.0 Page 19 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 YA23 Regulation 13 Requirement Timescale for action 27/01/06 2 3 YA23 YA24 13,19 23 Clear records of monies held by the home on behalf of residents that allow audit trails to be undertaken, must be maintained. All staff to receive training on 27/05/06 abuse issues. Upgrading programme to be 27/09/06 undertaken as planned. 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 Refer to Standard YA6 YA20 YA24 YA34 YA41 Good Practice Recommendations Key workers to meet regularly (for example, monthly) with their key residents; staff to receive training/instruction on their key working role. Policy on covert medication to be available. Locks to be repaired in downstairs toilet and bedroom of resident, BW. Recruitment checklist to be developed and used, that includes recording dates CRB/POVA First checks are applied for and returned. All records and documentation relating to residents to be signed and dated. DS0000023503.V265336.R01.S.doc Version 5.0 Page 20 Paddock House Commission for Social Care Inspection Kent and Medway Area Office 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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