Inspection on 30/12/08 for Pelham Manor

This inspection was carried out on 30th December 2008.

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

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

Pelham Manor 16/01/07

Pelham Manor 05/12/05

Pelham Manor 21/06/05

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pelham Manor 31 Pelham Road Gravesend Kent DA11 0HU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Mills     Date: 3 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Pelham Manor 31 Pelham Road Gravesend Kent DA11 0HU 01474352591 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : claire.meredith@nas.org.uk National Autistic Society care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users to be accommodated is 7 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Learning disability (LD) Date of last inspection Brief description of the care home Pelham Manor is a care home providing personal care and support for seven 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 Gravesend town centre. Shops, pubs, main post office, banks, places of worship, adult education college and other amenities are easily accessible. Bedroom accommodation comprises seven single rooms, three on the ground floor and four on the first floor. One bedroom has an en-suite bathroom. Communal rooms consist of two lounges 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 workshops in Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home 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. The fees range from £1150 to £3250 per week and are based on the assessed needs of the individual service user. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced and formed part of the inspection process of the Commission for Social Care Inspection (CSCI) under the Care Standards Act 2000. This report is compiled using evidence gathered during this visit and information that we have received about the home prior to this visit. This includes information that the home has sent us, such as their Annual Quality Assurance Assessment (AQAA) and notifications about any significant incident that has occurred, that is required under the Act. The views of the people that use the service and their supporters were also taken into account when compiling this report. The outcome of this inspection will result in the home being given a star quality rating. During the course of this visit three people that use the service were spoken to and Care Homes for Adults (18-65 years) Page 6 of 28 their interaction with staff was observed. Following the visit, three relatives were contacted by telephone to find out what they thought of the service. Documentation, including care plans, staff files and some policies and procedures, was examined. An in depth look was taken at the way medicines are managed in the home and a tour of the home was made. No requirements or recommendations were made as a result of this visit. The people who use this service, the staff and the registered manager are all thanked for the warm welcome they gave and for their help with this inspection. Relatives of the service users and health and social care professionals are also thanked for their input into the process. The outcome of this inspection is that the home has been judged as excellent and is therefore given a 3 Star rating. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives the people who use this service and their supporters the information they need so that they can understand their rights and responsibilities whilst living in the home. Appropriate pre admission assessments have been made and are regularly reviewed. This means that only those people whose needs can be met have a place in the home. Evidence: The home gives the service users information in a way they can understand. Direct and indirect observation showed that they understand their rights whilst living in the home. Relatives said that the home gave them good information prior to offering a place at the home. They say that the home continues to keep them well informed. No new service users have been admitted to the home since the last inspection. There are comprehensive pre-admission assessments on file. There is good evidence to show that regular care reviews take place. Care Homes for Adults (18-65 years) Page 10 of 28 Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service are supported to make informed decisions about the way they live their lives. This promotes their independence. Evidence: Four care plans were examined in detail. All contained good information about life histories, life styles and likes and dislikes of the people who use this service. Equality and diversity issues are noted in the plans and there are clear directions as to how religious and cultural needs are to be met. There are several different ways in which the service users are helped to make informed choices and decisions. In day to day life in the home flash cards are used to help facilitate choice. Staff were noted to use clear verbal prompts to help the service users choose what they want to do and what they would like to eat and relatives said that they are consulted appropriately when important decisions are needed. The decision making process is noted in the care plans. Care Homes for Adults (18-65 years) Page 12 of 28 Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people who use this service a wide range of educational, cultural and leisure activities. This promotes their independence and learning. Evidence: The service users take part in a wide variety of activities. Person centred care planning means that activity programmes are tailored to each service user. Activities in which they particulate include horse riding, swimming, specialist events such as car shows, cinema and pub visits. Some prefer to spend time in their rooms but are encouraged to particulate whenever possible. All the service users have the opportunity to go away on holiday. They were busy choosing their next holidays at the time of this visit. Recently some have managed to take holidays abroad. Nearly all the service users are able to go home to spend time Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: with their families. Relatives said that the home is very good at helping them arrange this and providing support for them at times when they need it. Every service user has an allocated time when they are supported by staff to particulate in the day to day running of the home. They work with staff to choose the food they want to eat and to go shopping for this. They are supported to cook, do their own laundry and to clean their rooms. The person centred care plans note the support each service user needs. There are also very clear directions about how any behviours, such as increased anxiety and attention seeking behviours, are to be managed. This ensures that all staff take a consistent approach to supporting each service user. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and well being of the people who use this service is positively promoted. This means that they can live as healthy a life as possible. Evidence: The health care records of the service users are very well maintained. There is a separate file for the health record of each service user and another file that explains the needs of the service user should there be a hospital admission. These records show that all necessary hospital and general healthcare appointments are made and kept and that the advice of visiting healthcare professionals is recorded and followed. Conversation with staff and the registered manager showed that they have a good understanding of healthy lifestyles. They spoke of promoting healthy eating and said that they try to ensure that the service users take plenty of exercise. They go swimming, horse riding, take plenty of walks and get out as much as possible. Medication in the home is very well managed. Storage is safe and secure and staff are very clear about medication policies and procedures. The medicines Administration Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Records(MAR) are in good order. There are no controlled drugs in the home but the home does have a cupboard for these should it be needed. Only staff trained in the administration of medicines are permitted to administer them. It was very good to note that the home is working closely with doctors and epilepsy specialists to try to reduce the amount of medication for some service users. Relatives praised the way the home works with them to ensure that everything possible is done to promote good health. They said that the home is very good at keeping them informed and supporting them to attend consultant appointments when needed. They praised the staff for the way they care for the service users. One said, The staff are excellent, they are very client orientated and understand their needs. They treat them as though they were their own. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views and concerns of the people who use this service and their supporters are listened to and acted upon. This means that the service does all in its power to protect the service users from harm. Evidence: There are sound policies and procedures for managing concerns, complaints and safeguarding. There have been no formal complaints since the last inspection. Direct and indirect observation showed that the service users are able to make their needs and wants known and that the staff respect their choices. Relatives spoken to said that they had never had cause to complain. They say that they can talk easily to the registered manager and staff and know how to make a formal compliant, although they made it clear that they didnt think this would ever be necessary. Staff spoken to said that they have had training in the safeguarding of vulnerable people. They were clear about their responsibility to report concerns if necessary. They said that they would have no hesitation in reporting concerns to the senior support worker or the manager. One member of staff said, The manager and senior are very good, we can talk to them at any time and they really listen to our ideas. I know they would act very quickly if ever there was any worry about the service users coming to any harm. Care Homes for Adults (18-65 years) Page 18 of 28 Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and has a friendly and relaxed atmosphere. This gives the people who use this service a pleasant and homely place in which to live. Evidence: The home had a friendly, relaxed and welcoming atmosphere. It is well maintained and was clean and tidy on the day of this visit. Since the last inspection there have been some significant environmental improvements. A large en suite wet room has been created for one service user whose needs have changed since coming to live in the home. A small lounge/dining room has been created. This is in addition to the existing lounge and dining room and provides a quieter area for some service users who find it difficult to be amongst too many people at one time. Outside there is a pleasant, safe and well maintained garden. However, the bathrooms are beginning to look rather shabby and dated and are in need of refurbishment. The registered manager stated that there is a continuous improvement plan for the home and that work on the bathrooms is scheduled for the next financial year. It is important that this work is carried out as soon as possible as there is a risk of two of the bathrooms presenting an infection control risk if work is delayed. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: No environmental health and safety hazards were noted on the day of this visit. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels, staff training, staff recruitment practices and staff morale are all very good. this means that the residents are cared for by a well trained, committed and cheerful staff team. Evidence: There are good staffing levels and these are adjusted depending on the number of service users in the home. At the time of this visit only three service users were at home, the remainder were still on home leave following the Christmas holiday. Staff spoken to said that they love working in the home and find it really rewarding. One said, Its more than a job. Staff spoken to said that there are always enough staff on duty to meet the needs of the service users. They said that that they have plenty of training and talked about the very thorough induction process that lasted six weeks and included a weeks observational placement. The staff spoken to were very clear about their roles and responsibilities. All staff working at the home are expected toward the National Vocational Qualification(NVQ) in Care at either level two or three, depending on their existing experience and qualifications. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Staff files show that appropriate checks are made prior to offering employment at the home. The staff on duty described the very thorough selection process that they had to go through before being offered a post in the home. One described the selection process which included a group interview that they had to pass before moving on to a probing individual interview. The registered manager said that the National Autistic Society have very strict guidelines about selection of staff to work in their homes. Staff say they are well supervised and have plenty of opportunities to put forward their views about the running of the home both at one to one sessions and regular staff meetings. They said that they get written feedback from these meetings and that communication in the home is excellent. They praised the way the home is managed and said that there is really good team work. Relatives praised the staff at the home and they way they work as a team. One said, The staff at the home are the best. They give so much of themselves and try so hard to work out activities that will interest the residents. My son loves cars and things to do with transport and they have taken him to special car shows and things like that. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. The views of the service users and their supporters are listened to and acted upon. This means that the home is run in the best interests of the people who use this service. Evidence: The registered manager was on a day off but returned from a day out in Hastings to attend when staff let her know that an inspection was in progress. Her action and help were much appreciated. She is clearly knowledgeable about care and is well qualified in management. She has a university degree in business studies, holds the National Vocational Qualification in Care at level four (NVQ IV ) and the Registered Managers Award (RMA). She is also an NVQ assessor. The home is part of the National Autistic Society (NAS). NAS is well known for its work in supporting people with autism and their families. It has a wealth of experience and expertise in understanding, dealing with providing service for people with autism. NAS also acts as an accreditor for other organisations dealing with autism. The home only Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: admits people with autism. There are very good quality assurance systems in place. A representative from NAS, for example, a registered manager from another home or an area manager, visits monthly to carry out inspection under Regulation 26. There are records of regular checks being made for all areas of the home including health and safety of the environment, the health and well being of the service users, service user views and medication. Relatives speak very highly of the way the home is managed and the support that the home gives them. Many gave examples of how the home helps them to have their relatives home for periods of leave and supports them when hospital visits are necessary. Staff said that the home is well managed and that they can put forward ideas and concerns and know that they will be listened to. No health and safety hazards were noted on the day of this visit. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!