CARE HOME ADULTS 18-65
Palm Care Limited 12 Hardy Road Greatstone New Romney, Kent TN28 8SF Lead Inspector
Geoff Senior Unannounced 15 & 21 June 2005 10:30 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. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Palm Care Limited Address 12 Hardy Road, Greatstone, New Romney, Kent, TN28 8SF 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) 01797 367006 01797 367006 Palm Care Limited Ms Regina Magigi Care Home only 6 Category(ies) of Learning Disability x 6 registration, with number of places Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07/09/04 Brief Description of the Service: Palmcare, Hardy Road is registered as a Care Home for up to six adults with a learning disability. Palmcare Ltd is the registered provider. Ms. G. Magigi is the Manager in day to day control of the functioning of the home. The home is a detached proprty set in a residential area of the seaside village of Greatstone. The accomodation comprises six single bedrooms for the service users. There is a lounge to the front of the house and a larger lounge/dining room with access to the enclosed rear garden. Car parking is available to the front of the property. Local facilities (shop, church, pub, post office and GP) are all within walking distance. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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 was undertaken on 15/6/05 between 10:30 and16:55. Contact with staff and service users was limited at this visit so a further visit was made on21/6/05 between 10:00 and 13:30. The inspector met and spent time with the manager, spoke generally with all staff and specifically with one. He also met with the area service manager who arrived to conduct a Reg 26 visit. The inspector spoke with two of the four service users who were at home during the course of the visits. One service user and another who was unsettled by the presence of the inspector chose not to communicate or participate. The Inspector viewed the premises and inspected a range of records; care plans, daily records, staff files and training records. What the service does well: What has improved since the last inspection?
The home has addressed the requirements and recommendations of the last inspection report. They have been met or have actions planned. The Manager has commenced RMA training. A number of staff have commenced or enrolled on NVQ training at level 2 or 3. The rear lounge/dining area has been extended to provide additional communal day space for the service users. Administrative systems and records have been reviewed and amended/replaced where appropriate.
Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 Stage 4.doc Version 1.30 Page 6 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. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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 Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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) 1, 2, 4, 5. The statement of purpose and service user guide provides service users and prospective service users with details of the service the home aims to provide, thus enabling a reasonably informed decision about admission to the home. Potential admissions are subject to pre-placement needs assessment. There should be a compatibility assessment to ensure the placement is mutually beneficial. EVIDENCE: The statement of purpose generally addresses the requirements of the standard. The manager will review and amend the company format to reflect the extent, limit and individuality of the service at Palmcare. The Service User guide is presented in pictorial form. The complete document is yet to be finalised. Keyworkers have read through and discussed the content with their clients. Referrals to the home arrive via the marketing department’s assessment. The manager then undertakes further care needs assessment. This should be signed and dated. The need to include assessment to ensure compatibility with existing service users was discussed Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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, 10. Good progress has been made to provide a clearer, more consistent care planning system providing staff with the information they need to meet service users needs. There needs to be a system of ensuring that all staff have read and understood behavioural guidelines to maintain their own, and service user safety. Confidentiality and security of information is maintained. EVIDENCE: Care plans contain an improved level of information in a more user friendly and informative format. Staff are required to cross reference entries in the daily reports with the care plan identified goal and targets. Where references are made in care plans or care needs assessments to behaviour management guidelines the manager needs to ensure that they are read, understood and signed by all staff. A list of independent advocates is available on request. Service users are consulted and encouraged to indicate their preferences or voice an opinion relating to mealtimes, activities or issues requiring service user participation. There was no public display of confidential or personal information. Records are securely stored. Risk assessments were not viewed at this visit. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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) 11, 12, 13, 14, 15, 16. Service users are encouraged to make use of opportunities to develop personal, social and living skills. Daily routines respect service users’ rights and individuality. Service users are helped to maintain appropriate family and social contacts. EVIDENCE: Discussion with staff and records viewed confirmed a diverse programme of activities offered to service users individually and as a group. Each service user has a written weekly programme in which they may participate or decline according to inclination. One service user has made sufficient progress in personal and social skills to now be assessed for an independent living placement. The home has a vehicle available for transporting service users to and from social, educational and activity venues and home visits. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 Stage 4.doc Version 1.30 Page 11 The service users may come and go as they please in the communal areas and grounds. The house is non smoking, service users and staff may use the garden room for this purpose. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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 Management systems are in place to monitor and review the on-going health needs of the service users. Staff are generally aware of the personal care needs of the service users and deliver care in a manner that promotes privacy and maintains dignity. EVIDENCE: Staff are aware of the need to maintain service user dignity and privacy when offering and supporting personal care. Staff interact with service users in a friendly and non-patronising manner. Flexible regime offers choice but encourages involvement in daily routines. Each service user has a key worker who is expected to monitor individual needs and ensure service users are supported to attend healthcare appointments. Staff liaise with external agencies for specialist input and advice. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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) 22, 23 The home has a written complaints system. This is also described in the service user guide. There was evidence that service user views are listened to and acted upon. Staff have limited awareness of Adult Protection issues, which would protect service users from possible risk of harm. EVIDENCE: A service user approached staff/management with issues of concern to him regarding his personal monies and accompanying other on a trip. Staff made an effort to listen to him, made suggestions to resolve the problem and reached a compromise to the satisfaction of all parties. Staff spoken to expressed a limited awareness and understanding of Adult protection issues and matters relating to physical interventions and would benefit fromspecific training in these areas. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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, 25, 26, 27, 28, 29. The standard of the environment within the home is generally good and provides the service users with a comfortable and homely place to live. EVIDENCE: An extension to the rear of the property will provide additional day space for the service users when carpeted and furnished. The manager agreed to provide the satisfactory completion certification. Service users make use of the enclosed garden and garden room, which is set aside for smokers. The premises appeared to be clean and free from undue odours. Private rooms are adequately furnished and are personalised. Toilet and bathroom facilities are adequate for current needs. There is no separate wc facility for staff use and limited space for the storage of their belongings whilst on duty. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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, 32, 33, 34, 35, 36. Recruitment practices have improved since the last inspection and provide for the protection of service users. Staff are accessing training courses to enable them to work more effectively with the service users. The staff team is well supported and supervised by the management and is clear about its roles and responsibilities. EVIDENCE: Staff were noted interacting with service users in a friendly and nonpatronising manner. Service users were seen approaching staff and management without inhibition and openly discussed issues they were upset or concerned about. The manager has commenced RMA training, 3 staff are on NVQ level 2or 3. Four are due to enrol once funding is finalised. Staff files viewed showed appropriate checks had been undertaken prior to appointment or unsupervised access to service users. Induction of staff needs to adhere to the programme timescales, one member of six weeks had day one only on record. Staff files contain a competency assessment to be used in the annual appraisal and development programme. Staff confirmed that they receive regular one to one supervision. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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) 37, 38, 39. The home is well managed and provides a caring and supportive service that promotes the health and welfare of the users. EVIDENCE: The Manager is working hard to improve and establish practices in the home. The service users and staff appear to benefit from the open and inclusive approach of the home’s manager and are clear about their respective roles. They have opportunity to express views and opinions in formal and informal forums. The CSCI receive regular internal audit reports in accordance with Regulation 26. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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 2 2 x 3 3 Standard No 22 23
ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 x 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 2 3 x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 2 2 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Palm Care Limited Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 3 3 x x x x H56-H05 S23506 Palm Care Ltd V226051 150605 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. Standard YA1 Regulation 4&5 Requirement Current and complete SOP and SUG which satisfies requirements of REG 4&5 to be forwarded to CSCI (previous time scale 30/11/04 not met) Staff to receive appropriate training in Adult Protection, managing physical/verbal aggression and physical interventions.Previoustime scale 30/11/04) Timescale for action 31/8/05 2. YA23 13 30/9/05 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 YA2 YA6 YA24 YA28 YA33 Good Practice Recommendations Pre Admission assessments to be signed and dated and to indicate where compatibility has been considered. Manager to ensure behaviour management guidelines are read and understood by all staff. Manager to forward completion certifiation and dimensions in respect of additional day space. Staff facilities to comply with the requirements of the standard. Manager to complete Res Forum Calculations re Staff levels.
H56-H05 S23506 Palm Care Ltd V226051 150605 Stage 4.doc Version 1.30 Page 19 Palm Care Limited 6. 7. 8. YA34 YA35 YA37 Two written references to be obtained prior to appointment Induction and foundation training to be to recommended standard and timescales and be recorded. Manager to continue RMA to completion. Palm Care Limited H56-H05 S23506 Palm Care Ltd V226051 150605 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
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