CARE HOME ADULTS 18-65
Peacehaven 43a Maldon Road Tiptree Colchester Essex CO5 0TS Lead Inspector
Jenny Elliott Unannounced Inspection 20th June 2007 10:00 Peacehaven DS0000017905.V343770.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 Peacehaven DS0000017905.V343770.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. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Peacehaven Address 43a Maldon Road Tiptree Colchester Essex CO5 0TS 01621 818220 F/P 01621 818220 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) Mrs Patricia Anne Payne Mrs Patricia Anne Payne Care Home 3 Category(ies) of Learning disability (3), Physical disability (1) registration, with number of places Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 3 persons) One person, under the age of 65 years, who requires care by reason of a learning disability, who also has a physical disability, and who has resided in the home since April 2002 The total number of service users accommodated must not exceed 3 persons 3rd October 2006 Date of last inspection Brief Description of the Service: Peacehaven is a family sized, semi-detached, chalet style property. The house is close to the centre of Tiptree. Peacehaven is the home of the provider/manager as well as to the three people cared for. The furnishing and routine of the home is family orientated and people living at the home consider themselves to be part of a family. There is a small garden to the rear of the property and parking to the front. Fees charged at Peacehaven range from £502 to £532 per week. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The information for this report was largely gathered during a visit to the home on 20th June 2007. At that visit discussions were held with one of the people who live there, the manager and deputy manager. One other person who is cared for at the home was also present and their interaction with staff informed the views of the inspector. The third person was out during the visit. Records were inspected and a tour of the premises undertaken. The people living at Peacehaven require a range of support related to their physical, communication and cognitive abilities. A range of concerns were identified at the visit of 20th June 2007. A number of these were serious and considered to be a potential risk to the wellbeing of people living at the home. As a consequence the most serious issues were raised with the home by letter and a follow up visit made to the home on the 16th August 2007 to check that the necessary action had been taken. What the service does well: What has improved since the last inspection?
None of the things that the home were asked to do at the last inspection had been done by the home. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 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 Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 People who use this service can expect adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Prospective service users can expect to have most of the information they require to make an informed choice about where they live and their assessed needs. EVIDENCE: No new people had moved into the home, there were no current or planned vacancies at the home. The assessment therefore remains as at the last inspection. The Commission does not have a copy of the Statement of Purpose relating to the home and the manager was not aware of the need to provide this. The manager advised that a copy would be sent to the Commission. The contracts seen on care plans did not provide people with sufficient information about their rights and responsibilities in the home. At the second visit to the home a copy of the Statement of Purpose was provided. This will be considered, along with other information, when the home is next inspected. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use this service can expect adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living at the home are consulted on day-to-day decisions within the home. The home did not identify or address longer-term aspirations well. EVIDENCE: One of the people living at the home said they were very happy there and that the owner manager was more like their own family. Another person was observed during the visit. This person was unable to speak but presented as comfortable in their surroundings and with the staff. They were occupied with games that were appropriate for their age. Staff demonstrated that they understood this person’s needs and wishes through their actions. The manager and her daughter (a carer at the home) were keen to maintain this domestic and non-institutional approach at the home. The care plans in place at the home had not been changed for over two years. There were signatures under the review section to indicate that they had been reviewed at least annually. Staff had a good level of understanding about how
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 10 people liked to be helped, but not all of this information had been included in the care plan. One person living at the home said they did not get out as much as they would like. The manager said that there had been some difficulty in enabling this person to have trips outside the home following her (the managers) accident, which had limited her own mobility for some time. The manager recognised that temporary arrangements could have been made in the interim to support this person’s access to the community. The home had been proactive in supporting the person to contact their social worker about this issue but had not progressed the issue any further when no response was received. The ‘planned activities sheet’ for this person included two visits a week to a day centre. The person had not visited the day centre for about two years. Discussions were held with the manager about the appropriate way to keep records about people who live at the home. One of the people living at the home contributed to this discussion and was clear about the need for records to be held securely and separately for each person. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use this service can expect adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Not all of the people who live at Peacehaven can expect to lead fulfilling lives. EVIDENCE: As stated in the previous section, not all of the people living at the home were able to take part in activities of their choice. The care plans in place did not describe people’s aspirations or what steps would be taken to meet them. The manager and staff clearly cared for the people living at the home. In many respects they were supported to have ‘ordinary’ lives. For example keeping pets, accessing health services in the community and shopping for their lunch. However not all of the people were engaged in activities meaningful to them on a regular basis, such as attending training or development courses or a day centre. Whilst it is acknowledged that some steps had been taken to engage a social worker in improving one persons access to the community, more could have been done to progress this by the home or through, for example, the engagement of an advocate.
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 12 People who live and work at the home described for the inspector how some people chose their own food whilst out shopping and described a good range of food on offer. A mealtime had been observed at the previous inspection and was felt to be a good experience. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who live at the home can expect poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living at the home cannot be confident that they will receive the best personal or healthcare support. EVIDENCE: Records held at the home did not demonstrate that people’s personal and healthcare needs were sufficiently promoted by the home. People who live at Peacehaven presented as being happy and cared for. People living at the home clearly felt Peacehaven was their home and they were part of a family. The manager of the home was not sufficiently knowledgeable about her responsibilities as a registered person to be able to demonstrate that care practices promoted the best interests of people living at Peacehaven. The medication administration record for one person had been completed for six days beyond the date of the visit to the home. This record should be signed immediately after a person has been offered their medication, not in advance or in retrospect. The purpose of this is to act as a safeguard ensuring that the correct medication has been taken, or information about why it has not been taken so that appropriate action can be taken. The records should also provide an audit trail to ensure that all medication can be accounted for. The
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 14 manager took action to correct this error during the inspection but could not say why or how the error had occurred in the first place. One of the people living at the home may have the capacity to administer their own medication. A letter, which appeared to be written to the Commission, was on this persons file that said ‘ … one thing I can do [self-medicate] is taken away from me because your rules say medication has to be locked away and I cannot manage to use keys …’ This does not demonstrate that the manager had sufficient understanding of national minimum standards or Care Home Regulations (2001) which say that people’s independence should be promoted, and that medication should be stored safely. The manager had not sought advice about any other secure storage that would not require the use of a traditional lock and key. The care plans held for people included weight charts, one of these did not have an entry after October 2006. The inspector was advised that the person had been weighed but there had not been a change in their weight. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 15 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): 22 & 23 People living at the home can expect poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living at Peacehaven are not protected by the homes policies, procedures or recording practices. EVIDENCE: There have been no concerns or complaints received by the Commission or home since the last inspection. It was evident from the visit to the home that there was a good level of communication and understanding between people who live at Peacehaven and the people that care for them. Requests were addressed promptly and there was evidence that people felt cared for and part of a supportive family unit. However, the manager of the home must be clear about what boundaries and safeguards need to be in place to ensure people living at the home are protected. The home did not keep records in respect of the money it held on behalf of people living at the home. There was an (unsigned) letter (dated 24th July 2002) amongst the records of one person who lived at the home bequeathing any money to the manager and her family. The contract held on file did not protect people living at Peacehaven. It did not set out their rights or their responsibilities. At the second visit to the home, the records relating to the finances of people living at the home were looked at again. These new records were clearly laid out and included receipts related to expenditure made. The cash balances checked matched to balance totals held in records.
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 16 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 living at the home experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Poor health and safety practices outweigh the benefits of the relaxed, family style approach of this home. EVIDENCE: As has been described throughout this report, this service is provided in the manager’s home and run as a family unit. All of the accommodation is domestic in style in terms of size, decoration and furnishings. Specialist equipment has been provided for one person in terms of a bath seat, grab bar and wheelchair. The bath seat had last been serviced on 30th June 2006, the invoice for this service include the statement ‘First service in twelve years…’ The manager was not clear about how often it should be serviced. No further service had been booked. A new gas boiler had been installed in the home in March 2006. The boiler had not been serviced or checked for safety since it had been installed, no service or safety check was scheduled.
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 17 The decorative condition of bedrooms was variable. One bedroom was well presented with furniture, fittings and decoration in good order. One bedroom had a strong smell of urine. Staff advised that they were waiting for the cleaner to arrive. The bedroom windows were open to air the room. The manager stated that they did not want to put the person who occupied this room in ‘nappies’. The efforts to promote this person’s dignity and independence are commendable, but the home should seek on-going professional support about the best way to provide support to this person as well as dealing with periods of incontinence to reduce the impact of offensive odours. The third bedroom was, as identified by the manager, in need of redecoration and re-carpeting. The manager advised that this was mainly due to the fact that the person living in the room had two pets, including an old, ill dog. There were no plans to redecorate the room whilst the dog continued to live at the home. At both visits to the home the kitchen and communal areas were cluttered and there were several piles of laundry in the lounge. At the second visit to the home the manager was able to demonstrate that they had obtained insurance for the premises and business, that portable electrical equipment and fixed wiring as well as the gas boiler had been tested and a service contract was in place for the hoist. Renewal dates, where appropriate, had been entered in diaries to reduce the risk of key services and equipment being used in future without the necessary checks taking place. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 18 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 People living at the home experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who live at the home are not protected by the homes recruitment practice. EVIDENCE: It was of concern to note that, despite requirements being made following the last two inspections, the manager had failed to ensure that all staff had completed enhanced criminal record bureau checks. The inspector was advised that for one person this was in progress. No training had been undertaken by staff since the last inspection, but an update in first aid training was booked in the near future. The deputy manager was hoping to become accredited to deliver moving and handling training, and recognised the benefit of being able to carry out on-going supervision of practice in addition to formal training once this was completed. The deputy manager also advised that they had identified a training provider who could support her through the National Vocational Qualification (Level 4) managers’ award, but that to date funding had not been identified. Completion of this award should provide the service with up to date professional insight into good
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 19 practice with regard to personal care and support including the legal framework within which it is provided. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 20 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 live at the home experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living at the home did not have their safety or welfare promoted by competent or accountable management. EVIDENCE: It is of concern to the Commission that the manager of Peacehaven had not taken steps to ensure the service was adequately insured to meet any liabilities in respect of the home. This is despite the fact that requirements were made to rectify this at the last two inspections of the home. In addition the manager had failed to ensure that staff had undergone enhanced criminal record bureau checks or that equipment and services to the home were checked to ensure they were safe. The current registered manager advised that she found the process of inspection difficult, and that she relied heavily on the deputy manager for support in meeting legal responsibilities. The
Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 21 registered manager was observed, throughout the visit to the home, engaging in a comfortable, supportive and dignified manner with people living there. The manager said that she preferred carrying out hands on care to the managerial side of her role. The views of one service user were clearly taken on board by the manager during the inspection, and the conversation suggested that this had always been the case. However the home had not always taken sufficient steps to maximise the independence of people living at the home by providing, for example, secure storage that could be activated without the help of staff or advocates to pursue issues with the local authority. Following the last inspection in October 2006, the manager was required to submit an improvement plan detailing the action that would be taken to improve the quality of service (including the safety and wellbeing of people living at Peacehaven) at the home. The manager failed to produce this. At the second visit to the home the areas of most concern had been satisfactorily addressed. This is a positive response to the discussions held at the first visit and the letter of concern sent to the home following that visit. The manager was made aware of the need to ensure that the home operated in a manner that promoted the health and wellbeing of people living there and within the legal parameters of The Care Standards Act 2000 and Care Home Regulations 2001. Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 22 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 X 2 X X 1 X Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 23 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 YA34 YA37 Regulation 19, Schedule 2 Requirement Timescale for action 10/10/07 2 YA20 13(2) 3 YA20 YA37 13(2) You are required to supply to the Commission by 10th October 2007 evidence that an application has been made for an enhanced criminal records bureau check for all staff employed and adults living at the home. This is one of the checks that should be undertaken to ensure people who live at the home will be cared for safely. Previous timescale of 10th July 2006 was not met. You are required to undertake an 10/10/07 audit of medication on the premises against the records of administered medication, to confirm this was a recording error. This is to make sure that medication has been administered safely. You are required to review the 31/10/07 procedures within the home for the administration and recording of medication to ensure that recording errors are in future promptly identified. You are also required to identify suitable training in respect of the
DS0000017905.V343770.R01.S.doc Version 5.2 Peacehaven Page 24 4 YA23 YA37 17(2), 13(6) 5 YA24 YA37 13(4) 6 YA6 YA9 YA12 YA1 15 7 4 8 YA5 YA37 5 administration of medication, for all staff that carry out this task. This is to make sure that medication is administered safely. You are required to ensure there is a clear policy and clear records are in place in respect of the safekeeping and expenditure of service users money. This is to make sure that people’s money is being kept safely. You are required to have systems in place at the home to ensure all equipment and services are regularly serviced and/or checked for safety in the future. You must ensure that care plans reflect the aspirations of people so that they can lead fulfilling lives. You must supply the Commission with a copy of your statement of purpose, every time any change is made to it. You must review the contracts you have with people living at the home to make sure it gives full information about their rights and responsibilities. 10/10/07 31/10/07 31/10/07 31/10/07 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Peacehaven DS0000017905.V343770.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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
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