Inspection on 23/06/05 for Peartree House Rehabilitation Centre

This inspection was carried out on 23rd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Peartree House Rehabilitation... 28/09/09

Peartree House Rehabilitation... 22/09/09

Peartree House Rehabilitation... 09/07/09

Peartree House Rehabilitation... 19/03/09

Peartree House Rehabilitation... 20/04/06

Peartree House Rehabilitation... 30/11/05

Peartree House Rehabilitation... 17/11/04

Peartree House Rehabilitation... 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Peartree House Rehabilitation CentreName 8a Peartree Avenue Bitterne Southampton S019 7JP Lead Inspector Jan Everitt Unannounced 23 June 2005 08.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Peartree House Rehabilitation Centre Address 8a Peartree Avenue, Bitterne, Southampton, Hampshire, S019 7JP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02380 448168 02380 434260 Peartree House Rehabilitation Limited Mrs. Marie Kelly Care Home 42 Category(ies) of Physical disability (34), Physical disability over registration, with number 65 years of age (8) of places Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 - The number of persons for whom accommodation and nursing care is provided at any one time shall not exceed 32. The 10 service users who are accommodated in the satellite buildings mustonly be need of personal, emotional and living skills support only. 2 - Service users in need of nursing care must be accommodated in the main building only. 3 - No more than 8 service users may be accommodated at any one time in the category of PD(E) over the age of 65 years. Date of last inspection 17/11/04 Brief Description of the Service: Peartree House Rehabilitation Centre consists of a large house, 3 two-bedroom bungalows and four self-contained flats within the perimeter of the grounds. The home is situated on the outskirts of Southampton city and is within easy access of Bitterne village and local amenities. The home is registered with the Commission for Social Care Inspection to accommodate 42 service users of both sexes who have sustained brain injury. The service can accommodate service users between the age of 18 and 65 years. The home has conditions to their registration; that they can accommodate eight service users over the age of 65 with physical disability. Service users who require only personal, emotional and living skills support and have no nursing needs, are housed in the flats and bungalows with a dedicated team who enable these service users to live an independent life suited to their capabilities. Peartree House employs a multidisciplinary team that comprise of an occupational therapy team, physiotherapists, psychologist, speech and language therapist, a rehabilitation consultant, registered nurses and care staff as well as a full housekeeping staff. The atmosphere at the home was pleasant and the internal décor was well maintained and clean Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Peartree House Rehabilitation took place over an eight-hour period on the 23 June 2005. The service predominantly provides a rehabilitation service for young adults with acquired brain injury. At the time of the inspection the home was accommodating 39 service users, 31 of which were in the main house and eight accommodated in the satellite buildings that are provided for more independent living. The inspector was assisted throughout the inspection process, initially by the deputy manager and for most part, by the registered manager. The inspector spent a considerable amount of time speaking with service users, relatives, care staff, nursing staff, occupational therapist and assistants, physiotherapist and psychology assistant, chef and administration staff. Owing to the nature of a number of the service users’ injuries and the service user’s ability to respond and communicate with the inspector. This limited the number of service users from which the inspector could gain views of the service. The inspector recorded three service users’ responses but a considerable number of other service users were spoken to for a short time during the tour of the building. Throughout the day the inspector observed interactions between staff and service users and effective teamwork amongst the multidisciplinary team. Six relative/visitors comment cards were received by the CSCI prior to the inspection. The general feedback from these cards was a high degree of satisfaction. The negative responses around the complaints procedure not being available was not supported as the procedure is displayed on the reception area wall and is included in the Service Guide. A recommendation will be made that the manager ensures that service users and relatives are made aware of how they can access this procedure. A relative had chosen to complete a comment card anonymously and therefore the issues highlighted with reference to her son could not be specifically addressed. The general feeling and atmosphere at the home is positive and welcoming. Service users and relatives spoken with reported a high degree of satisfaction with their care and the services delivered in the home. Twenty-two standards were assessed on this visit of which 18 were the key standards to be inspected in the current inspection year of 2005/6. There were no requirements from the previous inspection report and action had been taken to address the two recommendations made in that report. What the service does well: Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 6 The home provides a multidisciplinary team of staff who assess and plan programmes of rehabilitation for people who have sustained serious head injury to meet their physical, social, emotional and psychological needs. The home has a key worker system, which can be any one of the multidisciplinary team and service users, in general, were able to identify their key workers. The care planning system is comprehensive and service user focused. All disciplines contribute to the care planning process and evaluate their planned care regularly. The house and the satellite buildings are well maintained and well decorated and provide a welcoming and vibrant environment in which service users can live and undertake their programmes of rehabilitation. The staff team are motivated and are provided with a variety of training appropriate to the client group. The atmosphere in the home is positive and service users are motivated to reach their full potential of independence. The mealtimes are social occasions and menus offer a choice of nutritious food. The chef is aware of likes and dislikes and menus are planned around these. The staff team were observed to work well together and have good personal relationships with each other and service users. . The staffing levels are sufficient to allow staff to spend time with service users and accompany them into the community for shopping or outside appointments. What has improved since the last inspection? The extension to the home has been completed to provide an extra communal space for service users to use. The room is bright and spacious and service users are looking forward to using the room. Two bathrooms have been converted into ‘wet rooms’ and service users spoken with were very positive and reported it made them feel ‘more independent and had more choice of when they could take a shower’. A newly appointed deputy manager is now in post to support the registered manager with management and also be clinically based for overseeing staff supervision. She reports that she is currently undertaking her induction programme and considers herself ‘very motivated.’ The garden has been landscaped and paths laid to allow easy access for wheelchairs to the various areas created for sitting and a barbecue area. Service users commented that they enjoyed sitting in the garden where barbecues are enjoyed during the summer Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 7 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. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3 A comprehensive assessment is undertaken by appropriately trained staff prior to the service user being admitted to the home. The home demonstrates that service users are supported by a trained multidisciplinary team to meet their goals and aspirations. EVIDENCE: The registered manager and one other member of staff undertake a clinical assessment of the prospective service user prior to their agreed admission to the home for a planned programme of rehabilitation. The assessments, which are multidisciplinary focused, are comprehensive in content: the assessment was viewed by the inspector as part of the care plan documentation. Service users spoken with informed the inspector that the manager had seen them in hospital or their previous placements and understood that they are there for the rehabilitation. One service users reported that the manager did not visit their home prior to their permanent admission but that they had been coming to Peartree House on a number of occasions for respite care, and therefore the home and she ‘already knew each other’. The home has a multidisciplinary team approach to assessing and meeting the needs of the service users and programmes of rehabilitation are formulated during the assessment period. The manager reports that relatives/representatives assist with the admission process and that the home works closely with the Primary Care Trusts and care managers at the assessment and admission stage and they share information gathered from Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 10 them. The inspector evidenced in personal records a transfer of information report from another clinical area. Service users spoken with reported that they came to Peartree House with the one aim of getting better and living an independent life at home or in the community in their own place. The manager reports that an advocacy service for the service users is proving difficult to obtain in this area as their client base do not have mental health problems. One service user was using an advocacy service at the time of the inspection. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 Service users are aware that planned programmes of care and rehabilitation are in place and that they are invited to participate in planning and reassessing as their condition changes. Service users are supported to meet their full potential as part of the programme to more independent living. EVIDENCE: Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 12 The inspector viewed a sample of care plans. The care planning system in place is multidisciplinary focused and all records can be documented by any one of the multidisciplinary team. A client care profile forms the basis of the information gathering. The multidisciplinary team undertake assessments and risk assessments and from this gathered information, programmes of rehabilitation are formulated. The rehabilitation programme for service users is based on developing independent living skills, communication and emotional and social skills. The system must be commended for being service user focused, with all disciplines involved in the service user’s rehabilitation programme documentation and evaluating the planned rehabilitation and care programmes in one central service user plan. The service users do not hold their own plans but are consulted on the plan if possible and appropriate. A number of service users spoken with reported that they were aware of their rehabilitation programmes and the programme was discussed with them when being planned. They reported that they were asked if they wanted to be involved with the planning and consulted when the plans were reviewed. Some service users reported to the inspector that they ‘don’t want to be involved I would not know what to say’ Another service user responded that he ‘could be involved but cannot be bothered. Another service user informed the inspector that he considers his needs are met and the staff talk to him about the care he needs and he tries to get involved. The inspector asked another service user if he was involved with planning his programme he replied, ’yes I am analysed alright, of what I can do and what I can’t do’. Service users sign care plans if they wish to and are able to. The inspector evidenced this in some of the care plans viewed. The manager reported that relatives usually have a great deal of involvement at the initial assessment and are invited to be involved with the planning of the programmes of rehabilitation. The manager reported that family involvement is important to gain information about the service user’s previous life styles and to help families to understand the repercussions of the type of injury their relative has sustained. A relative spoken with reported that she was very satisfied with the admission of her sister to the home and that she had settled well very quickly and was expressing happiness at being at Peartree. She felt confident that her sister was being well cared for and in a safe environment. The inspector spoke with a spouse of one service user. She could not praise the service highly enough and commented that her husband was in the ‘best place’. The home has a key worker system that has a specific involvement with the service user. The service users spoken with could identify their key workers and they understood their role and that it was their key worker they spoke to and related to if there were any specific issues they wished to discuss. Service users can choose their key workers if practical and can be any member of the multidisciplinary team and key workers are changed if there is a request from the service user should the relationship not work. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 13 Risk assessments are undertaken on admission and reviewed, Risks are identified and discussed with the service user/representative. Agreement is sought from the family to put in place strategies to lessen risk. A relative spoken with reported that she is with her husband all day and observes his rehabilitation in the physiotherapy department and is aware that whilst her husband is in ‘safe hands’ there is always the risk of falls. Service user’s reported to the inspector that they can live within their capabilities and are permitted to move around the area of the home as they wish and that they accept that there are risks involved with their rehabilitation whilst testing their boundaries. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 & 17 Service user’s programmes of rehabilitation include taking part in a variety of activities available. These include going out into the local community to gain independence and confidence and to promote personal development. The home is fully committed to enable service users scope for developing new skills and fulfilling needs to communicate with others. Service users maintain appropriate relationships with families and friends. A varied nutritious diet is offered with choice at meal times. EVIDENCE: The service users’ programme of rehabilitation encompasses all aspects of care, which includes leisure activities. The home employs two activities organisers. The home has an IT suite and most of the service users, who able to use computers actively use the email facility frequently. The inspector observed all computers being used and emails being received in large type to enable the service user to read the text. Service users reported that they can be ‘in touch’ with friends and family via email and is far better than the phone or writing. The home employs a person who specialises in IT. One service user was at paid employment at the time of the inspection. A service user spoken with from one of the satellite buildings reported that Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 15 someone from the local college was visiting him that afternoon to discuss an electronics course that he is keen to undertake. The home endeavours to accommodate all service users educational needs. Three service users talked to the inspector as they were going to the college for pottery classes. The inspector admired various exhibits of their pottery in their rooms, whilst touring the building. The rehabilitation programmes are prescriptive for some of the service users and they practice living skills with the occupational therapist in the specially adapted kitchen, physiotherapy in the department and staff were observed to be sitting talking to service users on a one to one basis. A weekly ‘problem solving group’ is held with the OT and gives service users opportunity to discuss their issues or verbalise any worries. The manager reports that these have been well supported. Art classes take place in the home and yoga classes are held also. The home now employs a qualified teacher and an art therapist who are included as part of the multidisciplinary team and this enables the home to meet the needs of the service users holistically. Service users spoken with considered their needs were being met fully, although ‘week-ends are quieter’. The service users integrate into the community as much as is possible. The home is close to local shops and on a bus route to the city centre. Service users attend local pubs, the theatre, football matches and venues of their choice. More able service users can shop with the support of a carer. The inspector noted that the service user’s programmes, which are displayed in individual’s rooms, include all visits into the community as part of their rehabilitation and evaluated in the care plans. Key workers escort those service users who are living in the independent living facilities of the satellite accommodation, to go to the shops and support them to buy their food. This was confirmed by a service user spoken with who reported that she had been shopping that morning and had prepared her own lunch in the OT kitchen and this was recorded by the occupational therapist in her care plans. The manager reported that one service user was on holiday with her parents in America. The atmosphere in the home was busy at the time of inspection with various activities taking place. Carers were communicating with service users individually, service users were in the physiotherapy department receiving treatment from the physiotherapist and the occupational therapists and their assistants were supporting service users to practice their living skills. A number of service users were going out into the community to various venues. The home has two vehicles to transport the service users to various venues. Two service users spoken with said they wished more was going on at weekends but could not identify what they would like to do but they got a ‘bit bored’. There was documented evidence that the home respects cultural and religious diversity. One service user recently admitted is Muslim and this was documented and his needs for worship and special diet were identified and documented on his assessment. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 16 Family and friends are welcomed to the home. A number of comment cards were received by the inspector from relatives and all agreed that they were made welcome to the home. One commented on the restriction on visiting at the times for planned programmes for rehabilitation. One service user relative was observed to be participating in the physiotherapy session with her husband and reported to the inspector that she was very involved in his care and that the home accommodated this and that she was extremely happy with the rehabilitation, especially the quality of physiotherapy her husband was receiving and that she hoped it would not be long before he returned home. She reported that she often took her husband out in the car for a drive. Service users are able to go home at the weekends if it is possible and appropriate. The manager reported that one service user goes home every weekend and was on holiday at the present time. The visitor’s book evidenced that many visitors come to the home daily. A number of close relatives spend long lengths of time in the home daily. Service users are able to entertain their relatives in their own room or in the communal areas. The manager reported that in general the service users do not seek to form close relationships with other people and that they become self-absorbed in their own lives and it is difficult to initiate close relationships other than with their families and old friends. The inspector viewed a sample of menus that described a varied, nutritious diet with choices at every mealtime. Alternative food was offered on the menu. The chef was spoken to and he reported that he is aware of likes and dislikes of the service users but in general they have good appetites. Service users reported that generally the food was good and that they received adequate amounts. A number of service users are able to prepare their own meals either in the adapted kitchen or in their own accommodation in the satellite buildings. One service user reported that she preferred to prepare her own meals, as there were certain foods she did not eat. The inspector noted that there were three course lunches some days and two courses other days but that the content of the menu was adequate. The inspector observed the lunchtime meal and the service users were enjoying the meal. Most of the service users eat in the dining area or in their own accommodation if they so wish. Several service users reported eating their meal in the adapted kitchen area. Service users’ relatives may have a meal when visiting. The inspector observed that assistance was given to service users who were in need of support whilst eating and this was undertaken in a respectful manner. It was noted that a number of service users were being tube fed and others had been assessed as needing soft or pureed diets. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 &19 The staff were able to demonstrate a good understanding of the core values of care whilst promoting service users independence and control over their lives. Service users emotional and health care needs are met. EVIDENCE: Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 18 The home has a key worker system and this is agreed with the service user before it is implemented. The home is able to offer same sex care if requested but the manager reports that this is not always possible. Service users have autonomy over the routines of their daily living taking into account the planned programme of rehabilitation. Service users spoken with confirmed that they could choose when to get up and go to bed within the constraints of their agreed programme. The inspector was told by a service user, who choose to lay in bed until later in the morning, that this is their choice as it allows them a degree of more comfort than spending long hours in the wheelchair. Preferences and choices are respected and documented in relation to expressing service users’ individuality. One young man informed the inspector via his typewriter that he was being taken to the tattooist the next day for further tattoos to his leg and was keen to show the inspector his other tattoos and body piercing. Service users spoken with highly praised the staff and one described the home as ‘fantastic especially the staff’. The need for aids and adaptations are assessed by the appropriate professionals and are provided to support the service users to live as much as an independent life as possible. Special adapted wet rooms have been installed on the ground and first floor to enable service users to be independent with meeting their hygiene needs. One service user spoken with commented that is was ‘great’ being able to go to the shower room when he felt like it and not have to wait for a carer to assist him in and out of a bath. The home is fortunate to have the services of a psychologist, physiotherapist, occupational therapist, speech and language therapist and dietician. The age range of the service users is varied and therefore very individual needs are identified. A number of service users smoke and a smoking room is provided for this purpose. The GP attends the home weekly and has a consulting room in the house for service users to be seen, respecting their privacy and allowing for examination if there is a need. Service users spoken with reported they see the GP sometimes if they need to. The home employs general nurses and a general nurse with an RMN qualification as well. To ensure continuity and consistency the plans for care and rehabilitation are central to the service users choices and aspirations and the progress is dictated by these. One young service user’s comments indicated that he had been at the home for some time and that his attitude was negative about physiotherapy and he could only focus on wanting to be back home. Conversely the inspector observed a young man in physiotherapy department putting so much effort into getting his balance right and that the amount of effort it took showed on his hot and perspiring face. The home supports the service users to access their NHS entitlements and escorts are provided from the home should a service user have an appointment in the community. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Service users and/or their representative were confident that their views and opinions are listened to and acknowledged during interactions with staff. The home has policies, procedures and staff training in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The home’s complaints policy was seen displayed in the front reception area and is also part of the Statement of Purpose that is available to all service users and their families. Comment cards received by the CSCI from relatives indicated that, in general, they were unaware of the complaints procedure. This was discussed with the manager, who reported that she is confident that if there were any complaints these would be directed for her to deal with. The inspector observed throughout the day that the relationships between service users and staff were good and that they would be happy to discuss issues of any concern and these would not be ignored. The problem-solving group also affords a forum for issues to be discussed. The service users who were asked what would they do if they wanted to complain, reported they would speak to the senior nurse or their key worker and then the manager One verbal complaint from a relative has been received by the home, which the manager was dealing with currently and she is awaiting a written complaint, which she will investigate. The manager maintains a record of any complaints. All staff are aware of the protection of vulnerable adults policy and procedure and given training on this, as part of the induction programme. The home has not received any allegations of abuse. The manager reported that some service users could become both physically and verbally aggressive purely by the nature of their head injury. If this is the case this is documented on a care plans to inform staff how to deal with these episodes. Staff are given training Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 20 in a psychology-based theory of what initiates this behaviour and how to deal with this appropriately. The inspector spoke with a trained nurse, recently employed, who described a course she had attended in London the previous week on dealing with various types of behaviour associated with head injury. She reported that she had benefited from this tremendously by being better informed about reasons why those with brain injury display certain behaviour patterns and how to deal with these. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home’s premises have been adapted to be suitable for its stated purpose. The home is homely and safe and is well maintained and meets service users collective needs .The home has a lively, vivacious atmosphere that helps to create a strong sense of purpose around the home. The home maintains good standards of cleanliness and hygiene both internally and externally. EVIDENCE: Peartree House is a listed building and as such there are restrictions on physical alterations. The home is well maintained by a team of maintenance men. The new lounge area recently completed has been kept in keeping with the old house and is constructed to a high specification. The new furniture for this room was to be delivered the following day and the room is anticipated to be in use within the following few days. The inspector observed that is was the dining area that the service users chose to congregate in, although there are various communal areas around the home to use. The extension lounge is next to this room and service users spoken with reported that they were looking forward to using the new room and that they had been told about the alterations quite a long while back. The manager reported that service users Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 22 had been consulted and very tolerant whilst the building works had been in progress. The house and the satellite buildings are decorated and furnished to a high standard with bright pictures around the walls. The rooms and especially the satellite buildings have been individualised by the service users with their personal belongings. Two service users who are living in the satellite buildings and are more independent, reported that they are very happy with their environment and they enjoy being able to come and go from their homes to the main house is they wish. One service user showed the inspector the vegetables he was growing in the garden. The inspector observed that the gardens in the satellite buildings were very overgrown and untidy and in need of being sorted out. This was discussed with the manager who reported that this is on the planning agenda for the coming year. The service users from the satellite buildings attend the main house daily for various therapies. The home was clean and tidy and this is maintained by a separate housekeeping staff. The garden to the house has been landscaped with separate gazebo and seating areas around the garden with a path leading to all these areas giving easy access to wheelchairs. A barbecue area has also been created. Some service users spoken with reported they enjoy the garden in fine weather. A service user spoken to when the inspector visited his room, which was very tidy, reported that he maintains the tidiness of his room and the cleaner comes to clean three times a week. The inspector observed a less tidy environment in some of the satellite buildings and the manager reported that service users are expected to keep these premises to how they wish to live in their independency, but that the cleaners visit these premises once or twice a week to clean floors and monitor the cleanliness. The inspector toured the building and there were no areas of the home that were noted to be unclean, unhygienic or malodorous. On the day of the inspection a group of staff were undergoing infection control training. The training matrix evidenced that all staff receive this as mandatory training. The inspector observed that staff were wearing protective gloves for appropriate tasks. The home has a small laundry with machines fit for purpose. The service users who live in the satellite buildings reported that they do all their own laundry and indeed on the day of the inspection one bungalow had a line of washing out. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34 & 35 Staff are aware of their roles and responsibilities within the home to benefit and enhance the service user’s quality of life whilst in a rehabilitation programme of care. The home employs a multidisciplinary staff group in sufficient numbers, with complementary skills to support service users to meet their rehabilitation needs. The manager operates robust recruitment procedures within this home when selecting all grades of staff based on equal opportunities and ensuring the protection of the service users. The organisation ensures that staff training and development is in place to enable the aims and philosophy of the home to be fulfilled and meet the changing needs of the service users. EVIDENCE: Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 24 The inspector viewed staff duty rotas and the home demonstrated that sufficient staff were on duty that were appropriately trained to meet the needs of the client base in residence at the time of the inspection. The home employs a multidisciplinary team who have defined roles as stated in their job descriptions. Several of the staff and the new deputy manager were spoken with during the visit and training being one of the topics discussed during this discussion. The OT assistant was spoken with and she reported that she is closely supervised by the occupational therapist and receives appropriate training and hopes to continue further training. She reports that she is confident within her role as an assistant. The new deputy manager was spoken to. She reported that she is still undergoing her induction period and that she is well supported within her role by the manager and multidisciplinary professionals. The manager reported that she is pleased to have a deputy who will take on a senior clinical role to allow her to focus on the management of the home. The staff reported that staff meetings takes place about three times a year that are minuted. Various communication systems are in place for service users who are unable to verbally communicate. The inspector observed that word cards were in some service users rooms to enable them to communicate with staff and others. Staff were observed to be communicating well with service users and that good relationship exist. . The clinical psychologist provides training and workshops for all grades of staff on brain injury and methods of communication. An example that good relationships and communication can evolve with time, was the conversation the inspector had with one of the young service users whose needs were complex and who was desperate to go home to live independently. With his impatience that it would take time, he confessed to the inspector that it was one particular nurse that he had built up a good rapport with that had motivated him, steadied him and gave him hope that he would be able to go home to his family, but that this would take time and effort. The home was in the process of recruiting more staff and there was an open day the day of the inspection that had generated much interest. A sample of recruitment files was viewed. These evidenced a robust recruitment process with all information stated in Schedule 2 & 4 of the Care Home Regulations being in place. Staff spoken with expressed satisfaction with their recruitment process and that a job description had been included in with the application form. They reported that contracts of employment are signed when employment is commenced and a six-month probationary period follows. The induction programme for care staff was viewed by the inspector and is based on the TOPPS standards and comprehensive in content. A sample of the completed programme was evidenced in staff personnel files. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 25 The inspector viewed a training matrix identifying all staff training in progress and training completed within the current year. Training needs are identified at the annual appraisal and during supervision. The home has a designated trainer in post with the responsibility to arrange all staff training, which is fully funded by the home. Staff spoken with reported that they have access to a variety of training appertaining to the client base and that they are encouraged to undertaken the NVQ level 2 qualification. of which 20 of staff have achieved. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 42 The manager is qualified and competent to run the home and is supported by a newly appointed deputy manager and senior clinical staff. There is no quality control system in place based on seeking the views of the service users, although other quality assurance monitoring of other systems in the home is undertaken. The registered manager ensures that policies and systems are in place to ensure the health, safety of the service users and staff. EVIDENCE: The registered manager is a registered nurse and is undertaking the NVQ level 4 in management at the current time. The training matrix seen by the inspector evidenced that the manager continues to attend training sessions in various subjects. The manager’ agrees that her job description sets out her overall responsibilities. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 27 The administrator and the training officer undertake monitoring and the quality assurance of the environment. Service users and relatives/representatives views of the service are not sought via questionnaires or satisfaction surveys and this was discussed with the manager regarding it being undertaken as part of the quality control system to ascertain the level of satisfaction with the services in the home. The manager reports that there is a relatives support group at which time relatives may voice their views and any issues. The home publishes a newsletter that service users contribute to. A requirement will be made from this finding. The inspector discussed with the manager the poor quality of the Regulation 26 reports that are received by the CSCI from the responsible individual that is part of the quality assurance system. She will discuss this with the Responsible Individual. The home has safe working practices and all mandatory training for health and safety issues was evidenced as taking place on the training matrix. Staff spoken with confirmed that they receive this training annually. Service users are risk assessed on their security when being able to come and go from the home freely and this is documented in the care plans The accident book was seen by the inspector, who noted it to be completed fully. The manager reported that the accident reports are audited monthly and analysed to identify risks and emerging themes. Service users spoken to report that they feel ‘safe’ within the home’s environment. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 28 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 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Peartree House Rehabilitation CentreName Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 29 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 St 39 Regulation Reg 24(1)(3) Requirement You are required to undertake a service user/relative satisfaction survey as part of the quality control system of the home. Timescale for action 30.8.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard St 12 St 24 St 39 Good Practice Recommendations It is recommended that the home review their activities programme during the week-end to reflect service users expectations. It is recommended that the gardens belonging to the bungalows (satellite building) be cut back and cleared of all rubbish It is recommended that more detailed reports of Reg 26 visits are completed by the Responsible Individual. Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 30 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Peartree House Rehabilitation CentreName H55-H03 S11441 Peartree House V218555 210605.doc Version 1.30 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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