Inspection on 18/11/08 for Phillips House

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Good 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

Phillips House 18/12/06

Phillips House 09/03/06

Phillips House 02/08/05

Phillips House 01/02/05

Phillips House 19/08/04

Phillips House 18/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Phillips House 5 Jesmond Road Clevedon North Somerset BS21 7SA two star good service The quality rating for this care home is: 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: Sarah Webb Date: 1 8 1 1 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Phillips House 5 Jesmond Road Clevedon North Somerset BS21 7SA 01275873447 01275547470 phillipshouse@freewaystrust.co.uk 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) : Freeways Trust Limited care home 13 Number of places (if applicable): Under 65 Over 65 13 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability- Code LD The maximum number of service users who can be accommodated is 13. Date of last inspection 1 8 1 1 2 0 0 8 A bit about the care home Phillips House is a home for people with learning disabilities, and is part of the Freeways Trust. Thirteen people live at the home. The home is near to the town and the sea front and people can walk there or catch a bus. They all have their own bedroom Fees range from 500 pounds to 800 pounds 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: two star good 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 How we did our inspection: This is what the inspector did when they were at the care home The inspector visited without telling anyone that she was going to come. The report has been written using the information we got before and during the inspection. The manager and deputy manager were at the home during the inspection and they gave us the information we asked for. We spoke with most of the people living at the home. We spoke to one staff member who worked at the home. We looked at four care plans of people that lived at the home. We looked at records that were kept in the home that included Health Action Plans and Health and Safety records. We also looked at other records that we have written about in the report. What the care home does well The staff help people to communicate. People are supported to make choices about what they want to do such as activities. People are listened to and know how to make a complaint. What has got better from the last inspection People are helped to make decisions about their health. Health Action Plans include information about health checks. The balcony at the front of the house has been checked to make sure it is safe for people to use. An action plan has been sent to us to show how the home is kept secure Although the sleeping in arrangements for staff have not changed, the home has talked to us openly about how changes could be made. What the care home could do better Make sure there are always enough staff on duty to support people living at the home with their needs. Talk to people living at the home regularly about staff doing their sleeping in duties in the two lounge areas and if they are happy about this. Make care plans more accessible, with pictures, to help people who need support with their communication. The manager was also told to make improvements in some other areas. This is written in the report. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Webb Colston 33 33 Colston Ave Bristol BS1 4UA 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 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 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 . People who want to use the service are given information to help choose a home that will meet their needs. Peoples needs are assessed before moving to the home to help ensure they can be met. People benefit from visiting the home to see what its like. Up to date contracts help to show what people can expect from their stay. Evidence: The home has a Statement of Purpose and a Service user Guide providing information for people about the home. The Service User Guide uses clear, plain English with pictures and symbols to help people understand what the home has on offer. Some areas of the homes environment has been changed since the last inspection. A bedroom has been extended and security measures have been improved. The manager was advised to include these changes in the Statement of Purpose. There have been two new people admitted to the home since the last key inspection in 2006. Care files showed that they had been assessed before moving to the home to help ensure their needs can be met. We spoke to them and they told us they had been involved in making a decision about their choice of home. They had visited Phillips House to have a look around and to meet the staff and other people living there. At the previous inspection, other peoples care files were also seen to have pre admission assessments carried out by social workers. One person has been listened to and supported in moving from the home. People are given contracts, or service user agreements, that include the amount of the Evidence: fees paid to Freeways, their personal allowance and the contribution people have to pay towards transport provided. These were also in clear plain English with pictures and symbols to help communicate the information. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are involved in the planning of their care. Care planning shows how people want to be supported with their needs. People make decisions about their lifestyle and all aspects of the home. Risk assessments and reactive strategies support people to take risks safely as part of their lifestlye with some needing review. Evidence: Care files contained alot of relevant information to help staff support people with their needs. However some older information needs to be moved out of current care files. It was evident the home supports and involves people in a person centred approach to the planning of their care. Written information about routines, lifeskills, and leisure preferences had been recorded. Discussion was had with the manager about developing care planning further in an easy read format with pictures to give people a better understanding of how their care is provided. The home has a key worker system where each person has a named member of staff who plays a key role in helping them to plan their care. Records are kept of monthly keyworker meetings when a written summary is developed with the individual. These told us about their health, leisure and social activities. An environmental check of peoples rooms is also included to help keep people safe and make sure their needs are met. Summaries seen found that some were more up to date than others. A record is kept of peoples daily activities and general well being. However, not all the entries gave enough detail to help monitor all changes and provide information for the monthly reviews. Evidence: Yearly care plan reviews take place where all aspects of peoples care and lifestyle is discussed including peoples personal safety and how they are helped in taking risks safely. The majority of people have had a review or have one planned. These showed alot of clear information is recorded, how people have progressed and with their future aims for the future. People are encouraged to make choices and decisions about the way they want to live. People told us they have house meetings when they can say how they feel and what they want. However records showed that the last house meeting had been held five months previously. People have set their own rules to include no bullying in the home. People said they can also join working groups and Freeways forums to talk about different things. People are helped in being supported with their communication needs. A sign of the week Makaton sign is displayed in the kitchen so everyone is aware of it helping some people to communicate. People are helped in taking risks safely. We saw written risk assessments including how people are supported in the home using the kitchen, and accessing the community in activities such as swimming and travelling independently. Some are in need of being reviewed so that any changes in peoples behaviour and lifestyle are taken into consideration. Written reactive strategies that help to support people with their behaviour were seen. A strategy for an individual stated that in some situations physical intervention may be needed. It was evident from speaking to the manager that this was not currently needed. This must be reviewed and if physical intervention is identified then staff must be trained so that people are supported safely. This will be followed up at the next inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from having opportunities for personal development and in taking part in social, educational and recreational activities. They are helped to keep in contact with their families and friends if wanted. People are being supported with their personal relationships and with the involvement of appropriate agencies. People are supported in making choices about their lifestyle and are helped to take responsibility in their daily lives. People benefit from a varied menu and can choose the food they like. Evidence: On the day of this visit, the majority of people were going to the Freeways day service at Leigh Court, for the day. We had the opportunity to speak to them before they left and they told us about the home and the different things they liked doing. Some people liked their work placements while others had opportunities in being involved in different groups at the day service and college placements. They also said they go into the local community to go swimming walking and having a coffee and horseriding. Some people told us they had been on holidays to Butlins and London. Written timetables confirmed people have an active lifestyle and are offered a range of interesting activities. Some people travel on buses by themselves while others are supported with the use of a mini bus. This is used for social events, trips, and shopping. People pay towards using the mini bus and records were seen where people had signed to agree to this. Evidence: People are supported in being actively involved in the running and routines of the home. Peoples routines include weekly food shopping, and preparing for meals. People have their own household tasks to do like dusting, emptying bins, sweeping the kitchen and general clearing up. Lifrskills days are when people stay at home and work with staff in cleaning and tidying their rooms. This was seen through written records and confirmed by people spoken with. This time also gave some people opportunities to go out to the local community with staff. People are helped to keep in touch with their families and friends. Some people visit their family regularly and visitors are welcomed to the home. This was seen in some peoples daily records of their activities. We were told by people that they have friends over for a meal and staff help in providing transport. We saw menus of the meals offered and these provided varied, and well balanced options. People decide what is on the menu and if someone does not like something then an alternative if offered. On the day of this visit people had chosen to have chicken fajitas and salad. Staff cook the meals and people take it in turns to help prepare. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported in the way they want with their personal needs. They benefit from healthcare needs being met. People are treated in a respectful way by staff. Medication procedures keep people safe. Evidence: Care files reflected how people wanted to be supported with their personal care. We saw staff approaching people in a calm and respectful way and including them in their conversations. We were told by different people I like the staff and they help me to do things for myself. Healthcare records confirmed people have access to healthcare services both in the home and the local community. Staff support people with making routine appointments to see health care specialists. People are registered with the local General Practioner (GP) and records showed visits to dentist, optician, and chiropody. A requirement has been met to support people if they are able to, in making informed decisions about their medical treatment. Agreements were seen and issues of consent had been discussed and recorded. Health Action Plans were seen in care files. These included how people wanted to be supported with their personal and healthcare needs including medication, weight and diet. A requirement has also been met for Health Action Plans to include routine health checks. Peoples emotional health and well being is monitored through reviews of their medication by consultant pyschiatrist. This was seen through records of visits. The home has a medication policy including arrangements for administering home remedies. Medication is kept secure. We saw medication profiles that showed how people are being supported with their medication. Three people self medicate and Evidence: individual risk assessments showed their knowledge and understanding of their medication. Staff also carry out spot checks to help monitor people are taking their medication safely. During the past year we have been told about some drug errors. We were told that the home has changed the monitoring systems and that this has helped reduce errors. Staff receive medication training through Freeways and their competency is assessed by the manager. 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 people living at the home feel confident to approach staff with concerns. People can expect to be protected from abuse and benefit form staff trained in abuse awareness. Evidence: The home has an accessible complaints procedure that is displayed openly in communal areas. The complaints log was seen. There have been thirteen recorded complaints since the last inspection. All but one complaint had a record and date of the outcome of investigation and action taken. The manager was advised to ensure all outcomes and actions of complaints are recorded to show how the home responds to and monitors complaints. People spoken with were confident they are listened to and their concerns acted on. People said they knew how to complain and tolds us there was a complaints form in the dining area. The home has policies and procedures to help ensure people are safeguarded from abuse. Staff are trained during their induction in adult abuse awareness and refresher training is provided annually. It was evident that the home follows its policies and procedures. Safeguarding referrals were seen and staff are supporting people appropriately with other appropriate agencies involved. The organisation operate safe financial systems for supporting people with their finances. This helps protect people from financial abuse. Financial risk assessments were seen of peoples understanding of money. The home have regular audits of peoples finances and an external staff member is responsible for the book keeping. 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 environment is homely, safe, clean and suitable for peoples needs. The practice of staff doing sleeping in duties in communal rooms needs to be reviewed regularly so that peoples wishes are respected. Evidence: The home is in a residential area within walking distance of the town, sea front and local amenities. There are gardens to the front and back of the home. Some bedrooms at the front of the house lead out onto a small balcony. A requirement has been met for the Trust to check the safety of the balcony. There is communal space for the number of people living at the home to be able to move around freely. A ground floor lounge and attic lounge provide a comfortable area for people to relax and watch television. There is a bathroom and toilet on each floor with most of the bathrooms having a shower. The home is well maintained and comfortably furnished to suit the needs of the people living there. Art work and photographs are displayed giving a homely atmosphere. All the bedrooms are single and have been personalised and decorated to peoples wishes. Since the last inspection, one bedroom has been extended to meet the required room size as set out in the National Minimum Standards. This now leaves one occupied room that is under size. The Trust has responded to a separate letter and to a requirement for an action plan to be submitted to us advising us of how security issues around the home will be met. Window restrictors are now in place and an automatic locking door now operates. Other areas of external maintenance have also been carried out. Staff are still sleeping in the lounges on the ground floor and attic during their sleeping in duties. The manager and staff aware that peoples wishes come first and if they want to stay up later to watch television in these areas then those wishes are Evidence: respected. The manager needs to keep this practice under review regularly and include it on the house meeting agenda. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from a trained staff team and with recruitment policies and procedures that help to keep them safe. People do not always benefit from an effective staff team to ensure their individual needs are met. Evidence: Apart from speaking with the manager and deputy manager, only one other care staff member was spoken to briefly. Other staff were not fully consulted at this visit and this will be a focus at the next inspection to help evidence that staff understand their role and responsibilities, and have an understanding of peoples needs. The staff rota showed there should be two staff on duty at the begining of the day. One staff member took people to their day service in the mini bus in the morning, but another staff member did not turn up to do their rostered duty. This impacted on two people who were staying at the home for the day as they were not able to go out. The home must ensure there are enough staff on duty to ensure peoples needs and wishes are met. Both the manager and deputy were involved with the inspection and with a planned meeting. Recruitment records confirmed that the manager follows the homes recruitment policies and procedures. This was seen through staffing files that had appropriate information such as completed application, evidence that a Criminal Records Bureau (CRB) and Protection of Vulnerale Adults (POVA) checks are received. Staffing files also confirmed two references are received before people are employed. New staff are offered an induction period and must complete a qualification in working with people with learning disabilities. They can then move onto being registered for a National Vocational Qualification(NVQ). Currently there are six staff who have this Evidence: qualification with the remaining four staff being registered in February 2009. Staff training files seen showed staff have completed key training in fire, first aid, food hygeine, and manual handling. Records showed that other relevant training has been attended such as Thinking about sexuality and relationships and Managing Violence and aggression. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home benefit from experiencing good outcomes with their interests at the heart of decision making and with their views listened to and acted on. Some areas of record keeping need to be improved and kept up to date so that peoples care can be better monitored. The home promotes the the health and safety of the people living at the home and staff. Evidence: Since the last inspection the manager has been registered with us and is currently in the process of completing National Vocational Level 4. She has previous experience of working with people with learning disabilities. Both the manager and deputy manager have attended relevant training to help update their knowledge. People are encouraged to speak up with their views being asked for through effective quality assurrance processes. Service user inclusion questionnaires were seen that had been completed. Questions asked included what improvements could be made and and how people rated their service. Responses were positive and an action plan was seen in response to peoples views helping the home to focus on areas that need improving. The results from the questionnaires had been feedback to people. This is good practice. As previously recorded in Standard 6 there are some areas of record keeping that need to be improved and updated. Recommendations have been made in these areas. Staff are responsible for the monitoring different areas of the homes health and safety procedures. Records were seen of water temperatures being monitored, electrical Evidence: safety, and environmental audits. Since the last inspection the local fire services have been consulted. A fire risk assessment was seen and action has been taken to assess peoples response to the fire alarm sounding and how staff should be supporting them. The home receives monthly visits from senior managers who monitor the management of the home and all aspects of peoples care. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 33 18 The registered person shall, 28/02/2009 having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times suitably qualified, competent, and experienced persons are working at the care home in such numbers as are appropriate for the healthand welfare of service users. Ensure there are staff on duty at all times to support people with their needs and wishes. 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 1 6 Provide more detail in written daily records of peoples general well being, activities and how they have been supported during the day. 2 6 Further develop care planning practice to include easy read, accessible formats to help people understand and involved in their care planning. Review reactive strategy for an individual and if physical intervention is identified. If so staff must be trained. Keep the practice of staff sleeping in communal areas under review so that the privacy of people living at the home is respected. 3 4 9 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. 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