Inspection on 23/04/08 for Palm Care

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Palm Care 20/06/07

Palm Care 17/06/06

Palm Care 29/11/05

Palm Care 15/06/05

Palm Care 07/09/04

Palm Care 07/06/04

Palm Care 17/02/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Palm Care Ltd 12 Hardy Road Greatstone New Romney Kent TN28 8SF Lead Inspector Geoff Senior Unannounced Inspection 23rd April 2008 10:30 Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 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 Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 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. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Palm Care Ltd Address 12 Hardy Road Greatstone New Romney Kent TN28 8SF 01797 367006 01797 367006 palm@beaconcaregroup.co.uk 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) Palm Care Ltd vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2007 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. There is no Registered manager. A person is in charge of managing the day-to-day functioning of the home. The home is a detached property set in a residential area of the seaside village of Greatstone. The accommodation 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. The reported fees for this service are between £1200-1470 per week dependent on assessed need. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star This means the people who use this service experience adequate quality outcomes. We visited the home on 23/4/08 to carry out a’ key inspection’ This involved a tour of the premises, a review of some documentation, discussion with the manager and staff, We spent some time observing lifestyles and relationships with staff. We spoke with people who live at the home and gave them opportunity to voice their experiences and opinions. The inspection also involved a review of information received about the service since the last inspection and information provided by the home for the purposes of inspection. The previous manager completed the Annual Quality Assurance Assessment document. The information it contains is limited in content and detail. All key standards have been assessed, and some additional standards where outcomes were established during the site visit. What the service does well: The manager and staff promote a friendly, relaxed and welcoming atmosphere in a homely setting. Staff are patient and understanding of the support needs of people living in Palm Care. They help and encourage individuals to develop daily living skills and to join in with the daily activities. Staff help people to see and stay in touch with families and friends. The staff are friendly and many have known the people living at the home for some time. This has helped them build trusting relationships. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 6 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 Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 8 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 Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. Assessment of needs are undertaken and visits to the home are facilitated to ensure that the home can provide appropriate support to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Acting Manager reported that there have been no admissions to the home since the last inspection visit. No admissions are imminent as, despite there being two rooms vacant, there is to be a period of consolidation following management and staff change. There are no reported changes to the admissions policy or procedure. The last report noted: ‘Discussion with a relative during the site visit confirmed that a lengthy introduction and assessment process had been undertaken by the home prior to full admission of their relative. One person at the home confirmed they had been given the option of choosing between this and another home prior to admission. Pre-assessment information and a written terms and conditions document is in place. A previous requirement to ensure terms and conditions information is made available to prospective residents has been addressed, however, a Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 10 simplified version that makes this information accessible to those living in the home should also be available.’ The manager reported that that they have obtained ‘widget’ programme for the computer in order to produce more user-friendly documentation plus picture cards and emotion cards to further improve communication. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. People who use the service experience adequate quality outcomes in this area. Staff have an understanding of individual needs, support routines and risks and have access to detailed supporting documentation. More clarity is needed on how to identify, record and progress individual aspirations and wishes. There are increased opportunities for people in the home to be more involved and make decisions. Risks are generally well managed This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample number of service user files were viewed; they broadly support people in a positive manner but do not clearly show what, if any, input service users have had. There needs to be more evidence that people have chosen the goals and that they really are a focus for their life. Some aspirational goals are being Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 12 developed, such as travelling to an outside venue for gardening and music making. Manager reported that he is reviewing All documentation. He feels that the case files are not informative/instructive enough, He indicated that he is fully aware of the need, and is intending to develop Person Centred Planning. One sample had the action plan and service user finance section blank. Daily records detail health, demeanour, activity and meals taken. Comments by staff indicate however, a lot more going on than is perhaps documented. The records tend to describe the basic activity but not what the person actually got out of the day. The manager has encouraged much more community involvement and seeking of stimulating activity out of the home Decision making around the house is better in practice than is represented in the care plans and records. People are, for example, choosing what bedroom they would like to have, how to decorate it, what activities they want to undertake. It was not clear how much service user activity there is in making snacks and drinks and getting involved in the day-to-day household chores. Risk assessments have been reviewed and endeavour to enable the service users to participate in a variety of activity. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience good quality outcomes in this area. People living in the home are provided with opportunities to be more involved in their daily routines and to be active and use the local community on an individual and group basis. They are supported to maintain links with their friends and family. Staff are aware of individual food preferences and provide a varied diet that people enjoy eating This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff continue to work positively with the service users to establish likes, dislikes and interests. They are supported by the Organisation to provide a range of activities and events for recreational and therapeutic purposes. The Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 14 Manager has reportedly initiated changes so they are more community based, more frequent and, more relevant to the individual. He is also intending to promote participation in outings for enjoyment sake rather than for the incentives offered. This was initially met with some resistance by some service users but a consistent and persistent approach is reportedly reaping dividends. Three of the four service users have reasonably full activity timetables that include attendance at a local day centre. The fourth member enjoys 1-1 outings and company of staff. All have chosen the venue for their holidays. These are not as a group but dependent on individual choice. Contact with family and friends is encouraged and facilitated. Visitors are welcome without restriction save convenience to, and compliance with, the service users wishes. People living in the home sit down together and enjoy their meals, staff are conscious of some residents who may over indulge in some foods and take steps to monitor this. One person reportedly prepares his own breakfast and does so routinely. There is an established menu that takes account of individual likes and dislikes and staff cater accordingly. Service users’ rights to privacy are respected at all times and the have unrestricted access to their private space. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. People who use the service experience good quality outcomes in this area. People in the home are supported and encouraged to be more independent and involved in their daily routines; health care needs are generally well supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are treated with dignity and respect and levels of privacy are maintained. All the service users require some assistance with aspects of personal hygiene and care. The Manager tries to ensure that the staff are instructed and supervised to provide this thoughtfully and sensitively. The Manager reported that they have obtained a ‘widget’ programme for the computer plus picture cards plus emotion cards to further improve communication and help service users express themselves. This should assist in ensuring the delivery of care is person centred. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 16 The health needs of the service users are monitored and addressed. It was reported that the home has developed positive relationships with the local health care professionals who provide a good level of support. The medication records and storage facilities were seen, It was reported that, although they are adequate for the immediate needs of the home, individual medication storage facilities are being purchased for service user rooms. This is seen as a positive response to the standard relating to service user retention and control of their own medication. Records were clear and up to date. The Manager reported that while he is satisfied that the staff members involved with medication have undertaken training and satisfied competency assessments, he intends to review all training and ensure all staff undertake and/or refresh topics relevant to their post and responsibilities. The Manager has also reviewed medication documentation and amended/removed or introduced guidelines where necessary. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. Service users are supported, individually and as a group, to understand the complaints procedure and how and where to express dissatisfaction if they are unhappy. Staff have attended training in protecting vulnerable people from the risk of harm. The arrangements for the management of personal finances is to be reviewed to ensure records and systems protect the individual. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager indicated a clear understanding about resolution of complaints through the Organisation’s complaints procedure and of adult safeguarding protocols. He is aware of the local safeguarding team and an understanding of how reporting systems work. Records of incidents are maintained and passed on as required. There are environmental restrictions regarding use of the kitchen however, service users may generally come and go as they please within and outside the premises. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 18 The home has provided accessible versions of the complaints procedure to the residents but this needed updating. As noted earlier, the manager has obtained the necessary software to facilitate this. Service users are encouraged to approach the Manager or staff to talk about any issues of concern to them. The office door is open and service users were observed coming and going without inhibition or restriction. It was reported that all current staff have now undertaken protection of vulnerable Adults training. Risks are managed well and staff indicated an awareness of behaviour triggers and indicators and when to implement de-escalation strategies. Individuals can reportedly access their personal monies as needed. It was previously recommended that the home discourage the build up of cash sums for any individual, and should review current arrangements as a matter of some urgency. The Manager reported that he understands this has been addressed. Two of the service users have local bank accounts in their name. Two have personal monies held in the ‘Residents Monies Account’ Palm Care Ltd. One case file viewed had the Service User finance details section blank. There was a receipt for personal expenditure on furniture but staff spoken to were not clear as to service user consultation or where it would be documented.The manager, having not been in post very long, has not reviewed this area but agreed to check on the status of each service user and ensure that records are kept and personal monies accounted for. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30. People who use the service experience good quality outcomes in this area The home provides a homely and well maintained environment in which to live and work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently registered to accommodate a maximum of 6 service users. At the time of the visit there were 4 in residence. The parts of the house seen to be used by staff and service users appear to be well maintained and in good decorative order. Bedrooms viewed in company with the occupant were highly personalised, decorated according to personal choice. It was understood that the service users may have their own bedroom door key. There is adequate communal space accessible to all and comfortably furnished. There are also areas where service users may seek solitude if they wish. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 20 The AQAA self assessment received prior to the inspection visit indicated all maintenance and service checks were up to date and complied with regulatory requirement. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36. People who use the service experience adequate quality outcomes in this area. The service users benefit from a committed and well informed staff group. The Manager needs to ensure and confirm that all statutory and service specific training requirements have been met. A regular pattern of staff supervision should be re-established. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff confirmed they had received appropriate induction into their role and this was evident in their awareness and understanding of individuals’ care and support needs and their assured and confident responses. Staff reported that they felt well supported by the manager and enjoyed their job. They had been receiving regular supervision prior to the previous manager’s departure. This has yet to be re-established under the new management. It was reported that, whilst service user numbers remain at four, there will be at least three members of staff on duty throughout the day. The Manager works Monday to Friday 9-5. There are no separate catering or domestic staff. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 22 It was reported that nine of the twelve staff have completed NVQ to level 2 or above. A training programme for April to July 2008 was available. This indicated actual or planned attendance at; fire safety, moving and handling and rectal Diazepam administration, Staff confirmed entire team completion of adult protection training. A training matrix was not available at this time, It needs to show at a glance what service specific and Mandatory training had been completed by staff and where gaps lie. Staff recruitment procedures are generally robust although there was no indication on staff files seen that people who use the service are involved in the recruitment process. At the time of the visit Mr Gordon was engaged in checking staff files and seeking confirmation of details relating to checks undertaken prior to appointment and commencement of duty. It was noted that the status of some staff members, stated on correspondence relating to their transfer from other homes in the group, was not consistent with their role at the home or on their T&Cs. The Manager agreed to seek further clarification and confirmation. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. People who use the service experience adequate quality outcomes in this area. The home is well managed and generally promotes the health, welfare and safety of people living there. The home consults with people living in the home but needs to evidence clearly how their views influence service development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager presents as an experienced and well informed individual. He voiced a commitment to improving the lives of the service users and ensuring that staff are adequately prepared to provide effective support. He has, in a relatively short period of time, fostered and open and positive ethos in the home enabling service users, staff and relatives to feed back about the Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 24 service. The ethos of the home ensures that people living there are routinely consulted about things in the home and are encouraged to make choices. There is however, currently no evidence of how this information is analysed, published and feeds into service development, this is an area that needs strengthening. Monthly monitoring visits to the home are carried out by senior managers, ensuring that the standard of care and documentation is maintained and the premises are in good order. Maintenance of the home is generally good with no reported currently outstanding problems. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x 3 x Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 26 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 20 Requirement The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. In that: The manager agreed to check on the financial status of each service user, bank accounts held and ensure that records are kept and personal monies accounted for. Staff to be offered regular individual supervision Timescale for action 30/06/08 1 YA36 18 30/06/08 Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 27 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 YA23 YA7 YA8 Good Practice Recommendations Care planning documentation to indicate user involvement and ‘person centred’ approach. Home to review current arrangements for personal allowance monies. To document and review where support is needed to manage own finances. The home needs to develop and improve communication techniques to be able to better support the service users to express their choices/needs and aspirations. 3. Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Palm Care Ltd DS0000023506.V361117.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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