Inspection on 21/06/05 for Pelham Manor

This inspection was carried out on 21st 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pelham Manor 30/12/08

Pelham Manor 16/01/07

Pelham Manor 05/12/05

Pelham Manor 12/01/05

Pelham Manor 13/07/04

Pelham Manor 11/03/04

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

CARE HOME ADULTS 18-65 Pelham Manor 31 Pelham Road Gravesend Kent DA11 OHU Lead Inspector Elizabeth Baker Unannounced 21 June 2005 15:00 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. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Pelham Manor Address 31 Pelham Road Gravesend Kent DA11 OHU 01474 352591 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) Ms Claire Meredith National Autistic Society Care Home 6 Category(ies) of Learning disability - 6 registration, with number of places Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12 January 2005 Brief Description of the Service: Pelham Manor is a care home providing personal care for six Adults with Autistic Spectrum Disorders (ASD). Pelham Manor is owned and operated by the National Autistic Society (NAS). The service was first registered in January 1996. The home is a large detached house close to the town centre of Gravesend. Shops, pubs, main post office, banks, places of worship and other amenities are easily accessible. Bedroom accommodation comprises six single rooms, two on the ground floor and four on the first floor. One bedroom has an ensuite bathroom. Communal rooms consist of one lounge and one dining room. The home does not have a passenger or stair lift. The property blends into the surrounding area and there is nothing to suggest it is anything other than a family house. There is a small garden at the rear of the property. A small parking area is available at the front of the property. In addition to the residential accommodation the NAS provides day care activities in a variety of locations in the Gravesend area for residents from this home, as well as from the community and two other associated care homes. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 3¾ hours. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. Of the five residents spoken with, three were also spoken with in private. Some judgements about the quality of care, life and choices were taken from direct observation, speaking with residents and practitioners and available records. Two practitioners were interviewed and the Manager assisted with the inspection process. Some records were seen as part of case tracking and to assess work on requirements and recommendations made at previous inspections. What the service does well: What has improved since the last inspection? The kitchen has been upgraded and appliances replaced, providing a much improved and brighter area for residents and practitioners to prepare and cook food. Medicine policies have been expanded to provide practitioners with relevant guidance in safely administering medications to residents. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 6 Mrs Meredith has strived to ensure care records contain enough information and detail for practitioners to provide residents with appropriate social and personal support, where this is required. A new care document has been introduced, which records important health, social and personal information on residents should they be transferred to hospital for treatment. All but two of the requirements made at the last inspection have now been completed. The outstanding requirements refer to proper provision for drug storage and hand wash facilities in a particular bathroom. These matters will be addressed as part of the environmental improvements currently taking place. 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. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) N/I No new residents have been admitted to the home since December 2003. Therefore no judgement has been made on these standards at this visit. EVIDENCE: Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Residents are treated with genuine respect and understanding by practitioners. Individual health and social care needs are well supported. EVIDENCE: The manager has strived to develop care records, which provide comprehensive information to enable residents to receive appropriate personalised support and assistance. Following residents’ annual reviews, all care plans are now in the process of being updated to reflect identified changes. Where there is a potential risk to both the resident and practitioners, risk assessments for moving and handling as well as environmental restrictions, are now recorded in greater detail. This minimises risks to both the resident and practitioners. A resident spoken with had a good understanding of his care needs and described how these were being met. The corresponding care plan included this information. The resident said staff support him in attending Doctors appointments if he has a health problem. In addition to care plans, daily link books are maintained on each resident, which record their care, behaviour and wellbeing whilst on planned absences Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 10 from the home, including day centre attendance. This provides practitioners with a complete picture of the residents’ daily experiences. Interaction observed between residents and support staff was positive and respectful. Residents were observed speaking freely with practitioners and the manager. Where residents’ requests were refused the explanation for this was given in an unhurried and non-patronising manner. Care records contained Hospital Assessments. This is good practice and ensures hospital staff have access to important health and other pertinent information prior to residents receiving medical treatments in an unfamiliar environment. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Links with the community are good and support and enrich residents’ social and educational opportunities. EVIDENCE: Residents spend their weekdays attending day centres operated by the National Autistic Society. These centres provide a vast range of activities including art workshops, computing, life skills and gardening. One resident said how much she enjoys the gardening sessions and likes to do a bit of gardening at home. Another resident described how he assists in preparing hanging baskets and tubs, which are then sold by the organisation to raise funds. The resident also said he enjoys horse riding, going to the gym, attending church and going bowling. The resident is attending an IT course in Dartford operated by Learning Direct. Residents are supported in taking annual holidays, with their parents or other residents. Two residents spoke of their recent holiday to a holiday camp in Somerset, which they both really enjoyed. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 12 The home has a mini bus, which transports residents to the day centres or holiday trips. A particular resident said he prefers walking to the day centre and likes to visit certain shops on his return to the home. The resident said he has good contacts with the shops’ staff and they keep a look out for CDs of his favourite singers, such as Eric Clapton and Paul Wellar and keep them by for him to purchase. A resident with reduced mobility is now able to participate more in daily activities away from the home, following adaptations made at one of the organisation’s day centres. This will undoubtedly improve her quality of day experiences. According to individual abilities, residents assist with food preparation and choice of menus. The refurbished kitchen has a unit, which is of a height, which enables a resident requiring a wheelchair to comfortably work at. Residents and practitioners were seen sitting together enjoying their evening meal at the conclusion of the visit. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Residents’ health and personal care needs are well managed and promote physical and emotional wellbeing. EVIDENCE: Residents were seen returning from their respective day centres looking forward to having a bath and changing their clothes. The day’s temperature had been in the high 80s. Residents buy their own clothes, or with support where this is required. A resident said he likes to keep his hair in a particular style and has a favourite hairdresser he always goes to. Care records contain information to enable practitioners to prompt residents with regard to personal hygiene where this is required. Five of the six residents are mobile and independent. However one resident requires assistance and has been provided with a hoist. This ensures the resident is safely transferred. Indeed a new extension is the process of being built to provide the resident with appropriate accommodation to meet her current assessed physical needs. Residents receive specialist care from psychiatric and epilepsy clinicians, where their assessed needs require this level of intervention. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 14 Residents are supported in taking their prescribed medications and practitioners complete charts as a record of such administration. With one exception charts had been appropriately completed. The exception contained unexplained gaps. To ensure residents are not denied their medical treatment, reasons for non-administration must be recorded. GPs review residents’ medication and blood pressure annually to ensure they are receiving appropriate care. The manager has updated and expanded the home’s medicine policies and procedures, which should assist practitioners in safely administering medications. The current provision for drug storage is not adequate. A new storage facility is planned in the extension currently being built. This will ensure residents’ medications are safely and securely stored. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Staff have an excellent knowledge and understanding of adult protection issues, which protects residents from abuse. EVIDENCE: The home’s complaint’s procedure in available in different formats, to meet the individual abilities of the residents. Residents are aware of how to make a complaint and are assisted in the process by the manager or their key-worker if this is their choice. A recent incident demonstrated to the Commission that the manager and practitioners are fully aware of action to be taken if an allegation of abuse is suspected. This ensures residents’ protection. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 28, 29 and 30 Although the current environment is adequate for most of the residents, the completion of the extension will vastly improve the comfort and facilities for all residents. The manager has a good understanding of the areas in which home needs to improve. Planning is in place and sets out how this improvement will be resourced and managed. EVIDENCE: Residents are responsible for keeping their rooms tidy, stripping their beds, and washing their clothes, according to their individual ability. Practitioners clean communal areas. Bedrooms are furnished as per residents’ choice. Because of residents’ autism, some residents like to keep their rooms and possessions in a particular way. Practitioners understand and respect this. Following the fire inspection of the home in August 2004 by an Inspecting Officer of Kent Fire and Rescue Service, the home was required to produce and submit a fire risk assessment for consideration. Although this has been completed by the manager and submitted to the appropriate Fire Station for Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 17 comment, due to a change of fire service personnel the matter has not been concluded. The Manager is now in contact with the officer’s successor and hopes the matter can be resolved quickly. This will ensure the residents’ safety. All residents have a single bedroom, furnished to match their individual choices. One resident said he has CD player and likes to listen to music in his own room. The home currently has one lounge and one dining room. The lounge is furnished with comfortable sofas and a TV. A more appropriate chair has been obtained for a resident with limited mobility. This chair enables the resident to sit in it as she wishes whilst also providing better support for her physical condition. The conservatory has been demolished to make way for the new extension. The new extension will include an additional sitting room for residents’ use. The residents expressed a lot of interest in the work being done and some have been able to have a supervised visit around the building. Residents are supported in washing their personal clothes. The laundry room is domestic in size and contains facilities for staff and residents to wash their hands for infection control purposes. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33,34, 35 and 36 Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Staff are multi skilled ensuring continuity of care and support. EVIDENCE: The manager and practitioners have a good understanding of residents needs. The organisation is committed to ensuring practitioners are appropriately trained. A practitioner interviewed said she has received training in Treatment and Education of Autistic and related Communication-handicapped Children (TEACHH); and Structure, Positive, Empathy, Low Arousal and Links (SPELL) as well as health and safety, food hygiene, moving and handling and First Aid. She is also undertaking her NVQ level III care course. Twenty-five percent of staff have attained NVQ level II care and have now started level III. Three members of staff have commenced NVQ level II. Practitioners were carrying out their duties in an unhurried manner. New practitioners are not permitted to work with residents at the home until such time as all vetting checks have been completed. This ensures residents’ protection. Practitioners are then required to work through an induction programme and undertake Learning Disability Award Framework-accredited training. Residents are encouraged to “quiz” new practitioners about their Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 19 backgrounds during the introductory process. This ensures residents are involved in the recruitment and appointment process of practitioners employed to share their home and provide them with support. Practitioners receive formal regular supervision with their manager, during which they discuss their support and development needs. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 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 and 43 Residents benefit from a well run and resourced home. EVIDENCE: The manager has worked with the residents of Pelham Manor for about five years. The manager has successfully completed eight units of an appropriate Registered Managers Award course and hopes to complete the remaining units some time this year. The manager is also undertaking an assessor’s award course. The manager attained a Bachelor of Arts (Hon’s) 2.1 in Business Studies in 2000. Residents are surveyed for their views on the service and facilities provided in the home. The results are now analysed and the findings explained to residents. Residents have weekly meetings during which various matters are discussed, including staff changes and things to do for the coming week. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 21 A stand-alone but NAS associated body assesses the home on an annual basis to ensure it meets the accreditation requirements of a care home providing care for residents with Autism. A local support committee group, made up mostly of parents, use some of the accredited standards to carryout their own spot checks on the home, to ensure it is appropriately run. The kitchen has been upgraded and fitted out with new appliances. This is a better and safer working environment for both residents and practitioners. Practitioners receive core training including moving and handling, First Aid and Food Hygiene, for residents’ safety. Incidents, which affect residents’ wellbeing, are recorded and reported to the Commission under Regulation 37 as required. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x 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 3 3 x 3 2 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pelham Manor Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 3 3 H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 23 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 YA20 Regulation 13(2) Requirement The home makes proper provision for storing medicines. This needs to be complied with as part of the extension works which are currently underway. This refers to the provision of a wash hand basin in the ensuite ground floor bathroom. This needs to be complied with as part of the extension works which are currently underway. Medication administration record charts must be accurately maintained, for auditing purposes. Timescale for action 31/12/05 2. YA30 23 31/12/05 3. YA20 13(2) 21/06/05 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 YA32 YA37 YA29 Good Practice Recommendations Fifty percent of support workers must be trained to NVQ level II care, by 31 December 2005 Mrs Meredith must complete the outstanding management units to obtain the requisite Registered Manager Award by 31 December 2005. A Fire Risk Assessment, acceptable to Kent Fire and H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 24 Pelham Manor Rescue Service, must be available at the home. Pelham Manor H56-H06 S24004 Pelham Manor V230167 210605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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