Inspection on 01/11/05 for Pia - Four Gables

This inspection was carried out on 1st November 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pia - Four Gables 06/11/07

Pia - Four Gables 22/06/05

Pia - Four Gables 23/02/05

Pia - Four Gables 04/08/04

Pia - Four Gables 02/03/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Pia - Four Gables Ingon Lane, August Hill Snitterfield Stratford On Avon Warwickshire CV37 0QE Lead Inspector Martin Brown Unannounced Inspection 1st November 2005 10:00 Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Pia - Four Gables Address Ingon Lane, August Hill Snitterfield Stratford On Avon Warwickshire CV37 0QE 01789 204615 02476 640146 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) People in Action Adam Webb Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2005 Brief Description of the Service: The home is a large domestic property in an isolated rural setting, providing accommodation and care for 5 young adults who have severe learning disabilities but have few mobility difficulties. South Warwickshire Primary Care Trust owns the property. People in Action manages the home. All of the five bedrooms are single without en-suite facilities. The home has large gardens with a decking area. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday, and lasted three hours. Staff were welcoming and helpful, and all but one of the people who live at the home were seen during the course of the inspection. What the service does well: What has improved since the last inspection? 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. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 7 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 the following standard(s): EVIDENCE: These standards were seen to be met previously. There have been no new admissions since the last inspection, nor are any anticipated in the foreseeable future. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 6,9 The home continues to have up-to-date plans and guidelines that inform staff in providing care and support to people living in the home. EVIDENCE: Individual care plans continue to be detailed and comprehensive. Guidelines regarding individual behaviours, particular those entailing risk, were seen to followed by staff. The manager advised that he intends to review some aspects of the care plans which follow a format designed by the organisation to be accessible to people with learning difficulties, but which may not always be the most suitable for the people living at Four Gables. A folder, ‘Guidelines for New Staff’, has been produced, which provides a useful baseline of ‘need to know’ information about the home and the people living there, in a clear, easily accessible format. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 14,17 The home continues to work well to provide a variety of beneficial activities. The serving of lunch typified the calm, positive, teamwork approach of the staff and its success in minimising disruptive traits and encouraging positive behaviour. The use of 1 to 1 staffing with one service user appears to be having beneficial results. EVIDENCE: People living at the home were out at various intervals during the inspection; two at day services run by outside agencies, and others at activities run directly by the home. Daily activities are pre-planned, but subject to residents being happy to do them at the proposed time. As the home is fairly remote, transport is used. One person returned from a trip to Warwick, walks and shopping trips were planned for others. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 10 One person’s care plan noted among his interests, churches. His Life Story book included photographs of recent visits to churches. At lunch time, staff were observed following guidelines and using their skills and knowledge to ensure that individual needs were catered for and that this was a positive and as relaxed affair as possible. Staff were observed to be clearly explaining lunchtime procedures to residents in a calm, reassuring, manner. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 18,19,20 Personal support continues to be offered in a way that is beneficial to the service users, ensures their physical and emotional needs are met, and helps improve their living skills. EVIDENCE: Staff and management were able to discuss confidently and knowledgeably the particular support needs of individual residents, and how these were provided. These were confirmed by written guidelines and by observation of practice. Outside specialists continue to be involved in training and the drawing up of guidelines, in, for example, epilepsy. Medication folders show clear recording, with clear administration guidelines. There were two instances where the staff had had to write in medication details of ‘as required’ painkillers, which had not been pre-printed by the pharmacist. The manager expressed concern that progress made with one service user by the use of one to one staffing may be undone if this is not continued for at least a further period. Guidelines, recordings, observations, and discussion with staff showed that this level of support was greatly assisting his progress. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 12 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 the following standard(s): EVIDENCE: These standards were seen to be satisfactory at the last inspection and were not looked at on this occasion. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 24,27,28,30 The home continues to be comfortable, homely and safe, and therapeutic by virtue of its setting and spaciousness. The general outlook of the building is marred by the bars on the windows, which not only look unsightly and institutional, but also restrict their opening more rigidly than more modern window restrictors might. EVIDENCE: The home continues to be well-maintained, both inside and out, with plenty of areas for people to create their own space if they so wish. The ‘activity room’ continues to be one particular person’s much-valued space. Staff were noted to defuse potential flash points by gently re-directing residents away from each other when one or other appeared agitated or unduly focussed. The size of the building more readily allows for this. The manager advised that the downstairs bathroom is due for renovation. The (plastic) mirror was cracked, and pipes (in the corner, behind the toilet) are exposed. Other bathrooms and toilets were in excellent condition. The home was clean throughout, with no unpleasant odours. Staff were all observing appropriate hygiene procedures. Windows still have bars on them. Being the same colour as the window frames, these are not necessarily immediately apparent, but once noticed, give a very negative impression. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 People living at the home continue to benefit from the support offered by an effective and well-trained staff team. EVIDENCE: These standards were met at the previous inspection. Observation of staff interactions with service users confirmed that guidelines were followed, and that practice was professional, and positive, with staff managing situations calmly and appropriately. Observed practice from staff with a variety of levels of experience was seen to be calm, sensitive and in accordance with agreed strategies. Staff continue to be positive about the quality and quantity of training, with mandatory and relevant training taking place. Currently, one-to-one staffing is provided for one resident where this has been identified as a specific need. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 15 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 A method of soliciting the views of relatives, other agencies and professionals would add to information such as life story books in demonstrating the effectiveness of the service provided. Addressing fire safety issues will clarify fire safety for all using the building. EVIDENCE: The manager advised home does not have a Quality Assurance system in place, and that this is to be worked on. At present, other than direct observation, the most accessible evidence of the quality of the service is provided by individual Life Story books, which show, primarily in photographs, with clear and simple captions, what notable things each person has been doing through the year. All doors with access to the garden were open, except for the door in the corridor next to the laundry, which was locked, in spite of being signed as a designated fire exit. The manager advised that he is to have a more suitable lock installed. The manager advised that the home has consulted with the fire officer regarding fire procedures, and that these have now been revised. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 16 Staff advised that during fire drills, at least one resident has refused to evacuate, preferring to stay on his bed. Downstairs doors now have alarmactivated door closures. Staff advised that these can be activated by noise other than alarms. The lounge door device was not working. The service was advised to consider, as a long-term aim, the installation of magnetic alarm devices, when the home next has a major refurbishment. The manager advised that he had discussed the obstacle presented by the bars on the upstairs windows with the fire officer, who had said they were not a problem in the event of a fire. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 17 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 Score X x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 2 3 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pia - Four Gables Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 3 x DS0000004280.V261422.R01.S.doc Version 5.0 Page 18 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 23(4) Requirement The fire procedure must include details of what to do if a service user refuses to co-operate in the event of the fire alarms sounding. The fire exit by the laundry must have a readily openable lock. The lounge door must have a working alarm-activated closure device. The home must have an effective quality assurance and monitoring system in place. A risk assessment is needed concerning the exposed pipes and the cracked mirror in the downstairs bathroom, until such a time as this room is renovated. The home must explore alternatives to the window bars currently on many of the windows. Timescale for action 10/12/05 2. 3. 4. 5. YA42 YA42 YA39 YA27 23(4) 23(4) 24 23(2) 10/12/05 10/12/05 10/02/06 10/12/05 6 YA24 23 10/02/06 Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 19 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. Refer to Standard YA20 YA18 Good Practice Recommendations The home should ensure that the pharmacist pre-prints all medications on recording sheets. It is recommended that one-to-one staffing, in accordance with agreed guidelines, be continued for one service user for as long as this can be demonstrated to be essential for his individual development. Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pia - Four Gables DS0000004280.V261422.R01.S.doc Version 5.0 Page 21 - 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. 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