CARE HOME ADULTS 18-65
Palmer Crescent (1) 1 Palmer Crescent Rushmoor Ottershaw Surrey KT16 0HE Lead Inspector
Marianne Barham Unannounced Inspection 10th November 2005 12:00 Palmer Crescent (1) DS0000013439.V261385.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 Palmer Crescent (1) DS0000013439.V261385.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. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Palmer Crescent (1) Address 1 Palmer Crescent Rushmoor Ottershaw Surrey KT16 0HE 01932 874478 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) Welmede Housing Association Ltd Ms Christina Liddington Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 18-64 Years 21st July 2005 Date of last inspection Brief Description of the Service: 1 Palmer Crescent is a large detached bungalow that has been extended to provide accommodation and care to six people who have learning disabilities. The home is owned and managed by Welmede Housing Association Ltd, with the staff being employed by North Surrey PCT. The home has a large lounge and also a smaller lounge, a good sized, homely kitchen and a well maintained, enclosed garden to the rear. All bedrooms are single occupancy, with two having en-suite facilities. There is a large bathroom and a separate shower room, both of which are due to be refurbished in the near future. The home has recently undergone refurbishment and redecoration providing a comfortable and homely environment for the service users to live in. The home has its own vehicle to facilitate service users activities and there is ample parking to the front of the building. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 12.00pm by Marianne Barham, lead inspector for the service. The inspection was undertaken over a period of four hours and was the second inspection in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. The manager, Christina Liddington was present and a total of three members of staff and one service user were spoken with during this inspection. The remaining five service users were not able to give their views on the service, however they appeared to be relaxed in the company of staff members and engaged in various activities throughout this inspection. What the service does well:
The service is run as a home, with service users being involved as fully as possible in its day-to-day activities. Staff members and service users were observed to have a relaxed, friendly relationship and there is warm, homely atmosphere in the home. The care plans for service users are well written, regularly reviewed and involve the service users at all stages. Great care and attention is given to ensuring that the service users’ communication needs and choices are understood by the staff team in the form of a ‘communication passport’ in place for each person. The service users are supported by the home to be a part of the local community and there is a full timetable of work and leisure activities in place for them to access. The home has a vehicle for transporting service users to and from activities and works with other homes managed by Welmede to access a wider range of activities and maintain friendships between service users. The service user spoken with is happy with the service provided, says that the staff team are kind and the home is nice. The service user is very happy about having a new bedroom and took great pleasure in showing it to the inspector. Members of staff spoken with said that they are happy working at the home, all had worked there for many years and demonstrated a high level of understanding and knowledge of the service users’ needs. All said they were well supported by the manager and received enough training and supervision to carry out their jobs. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 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 contacting your local CSCI office. Palmer Crescent (1) DS0000013439.V261385.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 Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A These standards were not assessed at this inspection. Please see report dated 21st July 2005 for detail on these standards. EVIDENCE: Palmer Crescent (1) DS0000013439.V261385.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): N/A These standards were not assessed at this inspection. Please see report dated 21st July 2005 for detail on these standards. EVIDENCE: Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 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 the following standard(s): 16 Service users’ rights and responsibilities are recognised and respected by the home. EVIDENCE: The home involves service users as fully as possible in the daily running of the home, they are encouraged to make choices about how they spend their time, who they spend it with, when to get up and go to bed and what to wear. Each service user has a ‘communication passport’ which details all aspects of there needs, actions and preferences regarding communication so that the care staff know the best way to approach them and can interpret their gestures and vocalising more effectively. All service users have a key to their room and have free access to all communal areas of the home including the gardens. The home has a policy in place regarding the protecting of service users’ dignity and respecting their privacy, of which there is a copy in the service users guide. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 11 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): 18 and 19 Service users’ physical and emotional health needs are met by the home and they receive personal support in the way they prefer and require. EVIDENCE: Service users’ preferences and needs regarding how they are supported is recorded in their care plans and also in the ‘communication passport’ as detailed previously in this report. Many staff members have worked with the service users for a number of years and are familiar with each person’s individual needs and preferences. All service users are registered with a local GP and access to the district nurse and other specialist health professionals is accessed through the practice. Psychiatric, psychology and dental services are accessed through the North Surrey PCT. Each service user has an annual health check carried out by the GP and any healthcare needs are recorded in their care plan. All visits from healthcare professionals needs are carried out in private and service users are supported to attend appointments when necessary. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users views are listened to and acted upon and they are protected from abuse, neglect and self-harm. EVIDENCE: The home has a comprehensive complaints procedure in place that gives clear guidance on the steps to follow when making or receiving a complaint. The procedure is available in a pictorial format to make it easier to understand for the service users. This is placed in the service users guide and a copy has been given to all service users and their families. The home has a complaints and compliments record, however has never received a formal complaint. The manager stated that there is good communication between the home and the service users families and that any concerns raised are dealt with immediately. The home has a policy and procedure on protecting adults from abuse and a whistle blowing policy. All staff members are made aware of these through the induction process and a read and sign system. The home also has a copy of the Surrey Multi-Agency Procedures. All members of staff in the home have received training on adult protection. The home has robust procedures in place for the reporting of incidents and service users finances and behaviour management guidelines are put into place and followed for those service users who require them. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 13 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, 29 and 30 The home is comfortable with a homely feel and is very clean and tidy, however it is not entirely safe as there is health and safety issues as detailed below that need addressing. EVIDENCE: The home has recently undergone a programme of redecoration and refurbishment in all areas except the bath and shower rooms. The service users and their families were involved in choosing the décor and furnishings in their bedrooms. The home is pleasantly decorated and comfortably furnished, with new carpets and curtains throughout and new settees in the lounge area. All areas of the home were seen to be very clean and tidy. A service user spoken with expressed great happiness with the décor and furnishing in the home. It was pleasing to see that a recommendation made at the last inspection on 21st July 2005 to purchase a larger medication cabinet has been met. It was disappointing to see that door retainers have still not been fitted to those doors risked assessed by the fire officer as being safe to remain open,
Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 14 despite this being made a requirement at the last inspection. A further requirement has been made that this is done. As well as the doors to the lounge, utility room and kitchen, bedroom six is in need of having a retainer fitted owing to the service user insisting on having the door open at all times and propping it open with books etc. A recommendation has been made that this is done. It was also disappointing to see that the floor and grab rails in the shower room have not been replaced as was required at the last inspection. This was discussed with the manager and the plan is to completely refurbish the shower room, at which time a new floor and grab rails would be fitted. The manager contacted the person responsible for these works during this inspection and was given a completion date of end of February 2006. This requirement has been carried forward and the date extended to 28th February 2006. A recommendation was made at the last inspection that the standard bath in the bathroom be replaced with an adapted bath as recommended by the minimal handling advisor following assessment at the service. No action has been taken as yet despite the service having been made aware of the potential risks. This has now been made a requirement owing to the increasing mobility difficulties of some of the service users and the risks this poses to themselves and the care staff. A timescale of six months has been given to this to allow for the works on the shower room to be completed first. A recommendation was also made at the last inspection that the trip hazard posed from the patio doors from the lounge to the garden should be risk assessed and action taken to minimise the tripping hazard, it was disappointing to see that this had not been done. Some of the service users in the home have mobility difficulties but do walk around the home and the inspector is concerned that a service user may try to go out of the patio door and fall as it is left open in fine weather to air the room. The manager stated that in the past the possibility of putting in a ramp was tried but was not feasible. A requirement has been made that a risk assessment is carried out and that a step down from the patio door and a handrail should be put in place so that service users can access the garden from this door more safely. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 Service users are supported by, an effective staff team however the manager requires supernumerary time to carry out administration duties. EVIDENCE: The home has an established staff team, many of whom have worked at the home for several years. The rotas were examined and show sufficient numbers and skill mix of staff to meet the needs of the service users. Any staff shortfall is usually covered on a bank basis by the staff working in the home. Members of staff spoken with said that they enjoyed working at the home, had a lot of support from the manager and received enough training and supervision to carry out their jobs. All members of staff on duty were seen to relate positively with the service users and clearly knew and understood them well. From examining the duty rota and discussion with the manager it is apparent that no office time is allocated to the manager’s contracted hours making it difficult for her to keep on top of the paperwork. A recommendation has been made that at least one of the manager’s shifts a week should be allocated as supernumerary to facilitate administration duties. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The views of the service users underpin the self-monitoring, review and development of the home. EVIDENCE: The home has house meetings that are attended by the care staff and the service users, with any issues raised by, or relating to service users recorded. Welmede Housing Association has recently introduced a service user customer satisfaction questionnaire that has been circulated to service users, their families and involved professionals. Monthly quality assurance audits are carried out by, senior managers and copies of these are sent to the Commission. Welmede also hold residents and advocates meetings for all service users to air their views and service users also attend the in house training sessions and are presented with certificates of training. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 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 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X 1 X 1 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Palmer Crescent (1) Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000013439.V261385.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? YES 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 24 Regulation 23 (4) Requirement The registered person must ensure that those doors identified in the fire officer’s risk assessment as being safe to remain open have appropriate retaining devices fitted to them. The registered person must ensure that a risk assessment is carried regarding the trip hazard posed through stepping out of the patio door in the lounge and that a step down from the patio door and a handrail be put into place to reduce the risk of service users falling out the door. The registered person must ensure that the floor covering and grab rails in the shower room are replaced. The registered person must ensure that the standard bath in the bathroom be replaced with an assisted bath as recommended by the minimal handling advisor. Timescale for action 10/12/05 2 24 23 (2) (a) (o) 10/03/06 3 27 23 (2) (b) 28/02/06 4 27 23 (2) (n) 10/05/06 Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 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 2 Refer to Standard 33/38 24 Good Practice Recommendations It is strongly recommended that the registered manager should have one shift per week designated as supernumerary from the staffing numbers in order to carry out adminstration duties. It is strongly recommended that when retainers are fitted to the doors as advised by the fire officer that bedroom 6 also has a retainer fitted owing to the occupant insisting on having the door propped open at all times. Palmer Crescent (1) DS0000013439.V261385.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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