Inspection on 22/01/08 for Peacehaven

This inspection was carried out on 22nd January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Peacehaven 13/01/09

Peacehaven 20/06/07

Peacehaven 03/10/06

Peacehaven 29/03/06

Peacehaven 22/12/05

Peacehaven 25/11/04

Peacehaven 27/05/04

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Paradise Lodge

Grangewood

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Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Peacehaven 43a Maldon Road Tiptree Colchester Essex CO5 0TS Lead Inspector Jenny Elliott Unannounced Inspection 22nd January 2008 10:00 Peacehaven DS0000017905.V359874.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.V359874.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.V359874.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 patricia.payne2@btinternet.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) 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.V359874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 20th June 2007 3. 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 currently charged at Peacehaven are £446.95 per week. Peacehaven DS0000017905.V359874.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. The information in this report includes information gathered during a visit to the home on 22nd January 2008 as well as information provided by the service, and other people connected with the service, since the last inspection. What the service does well: What has improved since the last inspection? What they could do better: Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 6 The home still needs to provide training for the people working at the home, so that they can help the people who live there better. The home also needs to provide more interesting things to do for people who live at the home. Where people are able to manage their own affairs the home must make every effort to provide suitable equipment. 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.V359874.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.V359874.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): 1&2 Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home had been there for some years. There had been no new arrivals since the last inspection. It was therefore, not possible to assess the current admission process in practice. The service had, though, produced a statement of purpose. This is a document required by legislation that outlines the service provided by the home. It is positive that the document has been produced. The document provides people who may want to move into the home in the future with information. The document would benefit from proof reading and from the use of pictures and uncomplicated language to make it easier to read and understand. There were a small number of inaccuracies in the document that were pointed out to the manager, for example that the home would provide nursing needs if it was what people wanted. The home is not registered to provide this type of care. The statement of purpose was not clear about the Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 9 range of needs the service can meet. It stated we ‘will try and accommodate peoples every need …’ the home is registered to provide care for people with a Learning Disability and one person with a Physical Disability. It is important that the home does not provide accommodation to people with other needs before it has been assessed as suitable to do so through the registration process. The document also states ‘Once the service user has been admitted into the home a full assessment of them will be carried out …’. An assessment should be carried out before a person moves to the home. This is important because it means the home can make a decision about whether or not they are able to care for the person. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 10 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 7 9 Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person living at the home had a care plan. The plans provided good information about the things people could do for themselves as well as the things they need help with. This is important because it helps people to maintain their independence. There was evidence that the plans had been updated as people’s needs had changed. This was an improvement on the situation at the last inspection. People living at the home had also had their circumstances reviewed in consultation with their social worker, but no record of the outcome of these meetings had been made by the home. It was not, therefore, possible to tell Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 11 whether any further changes were needed to the care provided. For one person a record of the review had been provided by their social worker. There was evidence during the inspection of people being consulted about day to day decisions, such as what they wanted for lunch and how they spent their day. The tone of the interaction and the response by people living at the home suggested that staff regularly consulted with people in this way. On one file there was an ‘infringement of rights’ form. This acknowledged that people’s rights had been restricted through the placing of a lock on kitchen door. It also outlined why this had happened. Alongside this was a risk assessment for one person who was prone to ‘getting up early and accessing kitchen’. The risk management steps on this form included ‘Regular fire drills’ but there was no evidence that these took place. One of the people living at the home was capable of administering their own medication. A risk assessment would need to be undertaken and a suitable lockable cabinet supplied for this to happen. This issue was raised at the last inspection, but had not been taken forward. It is important that the home takes action where possible to maximise the independence of people living in the home. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. People who live at the home have limited opportunities to participate in interesting community based activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Daily records were kept for each person living at Peacehaven. These gave a summary of how the person had spent their day and any significant issues. The daily records for all three people were looked at during the inspection. The records for one person, from the beginning of January to the 22nd (the day of the inspection) were looked at in detail. None of the entries indicated that this person had been out of the home in this three-week period. The same person had a ‘planned activities programme’ on their file. This programme stated the same single, in house, activity Monday to Friday and at the weekend ‘watching TV’ in the morning and ‘listening to music’ in the afternoon. Some Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 13 time spent in the home, watching TV or listening to music can be an important part of someone’s week, but if this is the only type of regular activity it does not describe valued or fulfilling activities or a meaningful life. One person visited a day centre during the week and their activities programme described weekends as ‘Watching TV, Videos, Reading and going on outings’. Their daily records for the period 01.01.08 to 22.01.08 did not mention any outings except visits to the daycentre. The activity programme for the third person was more varied and included shopping, play games, out for lunch. The daily notes showed that although they didn’t go to shops all of the days suggested by the activity programme, they did go shopping very regularly. The manager advised that this person had also been taken to see their mum recently, who had moved into a care home in Essex. One of the people living at the home said they were getting out more and on valentines day were going to the 02 complex with the manager and her daughter to see strictly come dancing. This person also said they would like to get a laptop when they had enough money and seemed quite keen to take part in activities outside the home, but was aware that there were financial restrictions affecting this. People living at the home had breakfast during the inspection. People had their breakfast at different times. The atmosphere was relaxed. The manager discussed with people living in the home what they would like for dinner and agreed to provide the range of food requested. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is adequate. People who live at the home can expect their health needs to be identified and met. People who live at the home cannot expect to be supported to retain and administer their own medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a range of health related information included in records belonging to people living at the home. It was positive to note that medication had been reviewed by GP’s, this makes sure that the medication people are taking is the best for their needs. The records also indicated that doctor’s appointments were made for other routine health needs and where appropriate support was provided when admission to hospital was necessary. The records belonging to two people included sheets headed ‘Weight record’. Both sheets had the same date entered, 01.11.04. Against the date for one person was their weight at that time, but no records had been made since that date. For the other person there was no weight against the date and no other Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 15 entries on the sheet. The manager said it was difficult to weigh one person because they couldn’t stand. The manager was advised to see further advice and assistance. It is important to be able to monitor weights so that changes can be identified quickly. It was clear from other records that not all contact with health professionals were entered on the specific sheets provided for this purpose in care plans. This might make it difficult for the home to give full and accurate information to health professionals in the future about a person’s medical history. It was disappointing to note that no progress had been made to identify a suitable lockable device for one of the people living at the home to store their medication in. The manager had advised at the last inspection that this was the only barrier preventing that person from being able to administer their own medication. The records relating to the amount of medication administered at the home were in order. A supply of painkillers was kept by a day-centre for one of the people living at the home. The home did not have a record of what, if any, medication was administered at the day-centre. It is important that the home is aware of this to ensure that the person does not receive more than the stated maximum daily allowance. The home also administered controlled drugs for one person. The records for these contained all of the information required, but the records were held on loose-leaf sheets. The records should be in a bound book, so that any amendments made to the records can be identified. The manager was observed administering some medication from her hand. This is poor practice in terms of infection control as well as the safe administration of medication. The deputy manager advised that a full range of medication policies had been developed since last inspection and that medication review dates on prescriptions had been entered into a diary to ensure appointments are booked. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. People who live at the home can expect staff to listen to their concerns, but cannot be confident that staff will have sufficient understanding of wider safeguarding issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had 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. Staff at the home had not received up to date training about how to promote the safety of vulnerable adults. The home kept clear records in respect of the money it held on behalf of people living at the home. Receipts were kept for expenditure made on their behalf. There remains a (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. It is unusual for individuals working in care homes to accept financial bequests. The status of the unsigned letter was not clear, it was not apparent that any independent advocacy had been involved in this Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 17 decision. These are important issues for the home to consider to ensure that any allegations of financial abuse could be fully responded to. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is adequate. People who live at the home benefit from its relaxed, family style. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At this inspection the lounge was clear of laundry, and much tidier than at the previous inspection. The Kitchen was tidier and less cluttered. A lock on the outside of an upstairs bedroom had been removed. The two upstairs bedrooms were pleasantly decorated and furnished. The downstairs bedroom had not been re-decorated. The manager advised the commission of the reason for this, but should consider how long they will wait before paying attention to the room. Certificates were in place to demonstrate that portable electrical equipment, as well as electrical wiring had been tested, and a gas safety certificate was available. Equipment used in the home had also been serviced. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 19 The latest Environmental Health Officer’s report stated the home must ‘obtain, complete and implement safer food, better business’. The Deputy Manager said they had obtained a copy and were working through the booklet. She was able to point to the purchasing of different colour chopping boards for different foods as an example of how they have begun to implement good practice. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is poor. People who live at the home can expect to be protected by the way it recruits people but not by the training it provides to staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new staff had been recruited since the last inspection. The service had though organised the records relating to current staff. All of these files were checked and all contained a current Criminal Records Bureau check. No progress had been made in respect of staff training since the last inspection. The manager advised that medication training had been booked but that the trainer had cancelled the course on the day it was due to be delivered and they were waiting for a new date. A discussion was held with the manager about how to set minimum standards in terms of training to meet the needs of people living in the home. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. The health and safety of people who live at the home is protected by the manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has not completed the Registered Managers Award, but has many years’ experience of working in and managing care homes. The manager and deputy manager work closely together and run the service in a very homely way. This has led to issues in the past, particularly with keeping records up to date and ensuring the home was a safe environment for the people who live there. It was pleasing to note at this inspection that most of Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 22 the issues raised at the last inspection had been addressed and improvements had been maintained. The financial records for two people were inspected. The system in place was clear and included numbered receipts that made it easy to audit expenditure. The cash balance was checked against the balance on each record book. The cash balance for one person was £10 less than the book indicated it should be. Discussion was held with the manager about how to incorporate checks into the system of managing other people’s finances. During discussions about improvements required to, for example, the quality of life and opportunities of people living in the home and staff training, the manager had reflected on the financial impact these costs have on a small home. The manager should be clear about the cost of providing good quality care. This is important to ensure the on-going financial viability of the home. A quality assurance process was not in place and home had not completed the Annual Quality Assurance Assessment (AQAA). All services are required to complete this form, it is important because it provides the Commission with up to date information. The AQAA was returned prior to the completion of this report, many parts of the form identified ways to improve the service currently provided for the benefit of people living at the home. This information will be used as part of the next inspection of the home. Most improvements at the home were related to health and safety. Records were in place to demonstrate that services and equipment had been serviced and checked and systems were in place to ensure that future checks would take place when required. Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 23 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 2 2 2 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 X 1 X X 3 x Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 24 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 YA9 YA20 Regulation 12,13 Requirement The home must ensure, through the provision of equipment and other measures, that people are able to take responsible risks in order to maintain their independence. The home must ensure that care plans reflect the aspirations of people so that they can lead fulfilling lives. This requirement did not meet the previous timescale for action of 31/10/2007 The home must ensure, through training and other means that, where medication is administered by staff, it is done so safely. The home must clearly identify the skills and knowledge needed by staff to provide care at t he home and ensure that training is provided to meet that need. The home must implement a quality assurance process that ensures services are developed in the way people living at the home want. Timescale for action 30/04/08 2. YA12 15 30/04/08 3. YA20 13 15/03/08 4. YA32 YA35 18 31/05/08 5. YA39 24 31/05/08 Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 25 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 Refer to Standard YA23 Good Practice Recommendations The home should ensure that where people living at the home make decisions about their finances that affect people working at the home, there is independent support for the person. The home should keep under review its decision to delay the redecoration of the downstairs bedroom. The manager should keep herself up to date with developments in the provision of care through appropriate training. 2 3 YA24 YA37 Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Peacehaven DS0000017905.V359874.R01.S.doc Version 5.2 Page 27 - 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. 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