Inspection on 22/06/05 for Pia - Four Gables

This inspection was carried out on 22nd June 2005.

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

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

Other inspections for this house

Pia - Four Gables 06/11/07

Pia - Four Gables 01/11/05

Pia - Four Gables 23/02/05

Pia - Four Gables 04/08/04

Pia - Four Gables 02/03/04

Similar services:

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 Stratford On Avon CV37 0QE Lead Inspector Martin Brown Unannounced 11.45 a.m. 22 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Pia - Four Gables Address Ingon Lane August Hill Stratford On Avon Warwickshire CV37 0QE 01789 204615 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) People in Action Adam Webb PC Care home only 5 Category(ies) of LD Learning Disability (5) registration, with number of places Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 23 February 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 E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection during the middle of the week, lasting four hours from 11.30am. During the course of the inspection all the service users were seen, the manager and many of the staff team were available. What the service does well: What has improved since the last inspection? What they could do better: There is always room for improvement when providing a service for people with challenging and complex needs. Person–centred plans for all will assist in having a bench mark for ensuring each individual’s quality of life continues to improve. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 6 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 E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home’s ability to meet the needs of service users admitted to the home is supported by detailed assessments. EVIDENCE: As noted on the previous inspection, the most recent placement at the home was someone who had previously lived there, and for whom full assessments had been obtained and done. There have been no further placements since. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Individual care plans reflect and guide the home’s efforts to help meet service users’ needs and goals. The implementation of person-centred plans for all service users would help this process. EVIDENCE: There are detailed care plans for each service users, covering their individual needs and wishes, and showing in life story books how these are met. Guidelines and risk assessments in individual care files show how individual behaviours and needs that could lead to risks are managed. Staff were seen to be following guidelines in managing and minimising behaviours and anxieties that could escalate into problems if not defused at an early stage. The home advised that possibilities of a more individual living situation was being explored for one particular service user, but that a person-centred plan had not yet been undertaken for this person. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 The home is able to support service users in taking part in a variety of desired and beneficial activities. EVIDENCE: Activities were taking place for individuals in accordance with the activities chart prominently displayed. Staff and the manager advised that frequently activities were revised, as service users wished to do different things, or nothing at all. Staff are able to respond to spontaneous wishes of service users, providing staffing ratios are sufficient. This was the case during this inspection, where staff were able to accompany a service user on a drive and a walk out. The kitchen was well-stocked; where necessary, snacks were pre-prepared, to anticipate service user coming for snacks when they wished, and thus helping to lower thresholds of anxieties and minimise disruptive behaviour. Staff advised that the evening meal tended to be the one occasion when service users tended to be together for an organised meal, except for those who decided to opt out of this, or who had other commitments. There is a locked kitchen policy in operation, but the kitchen is frequently open for supervised service user access. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 11 There are differing levels of family involvement, and service users are encouraged to socialise, but their wishes not to are also recognised and heeded. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Service users’ personal and healthcare needs are met in a manner suited to their physical and emotional well-being. EVIDENCE: Staff were seen to provide care and support in a consistent manner and in accordance with agreed guidelines to support service users, and in a way that helped to minimise disruptive behaviours. The support and advice of outside professionals, such as speech and language therapists, is sought where appropriate. Medication administration and recording was found to be satisfactory, with the exception of the practice of putting aside one medication tablet ready for potential use by a service user when he is out of the building for a prolonged period. This was not clearly accounted for in stock-taking, initially making records appear inaccurate. Additionally, the medication concerned had been removed from its foil, thereby reducing its effective life. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The policies and procedures of the home protect service users from abuse, and promote a culture where service users’ views are heeded. EVIDENCE: The complaints policy and the complaints file was seen to be satisfactory. The Service User Guide gives simple, clear guidance on how to complain. The manager acknowledged that the needs of the service users are such that the main concentration in the home is on staff understanding service users’ communication of their wishes and dissatisfactions in order to be able to respond positively and effectively to them. This was evident in observed interactions in the home. The restraint policy was seen. Priority is given to individual behavioural management, in order to pre-empt and minimise the need for restraint policies to be implemented. Service users’ day –to-day finances were seen to managed appropriately. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,30. The home provides a safe and comfortable environment that meets the wishes and needs of service users. These needs make regular maintenance a priority. Service users’ hygiene development will not be assisted if bathrooms do not have hygiene facilities. EVIDENCE: Service users live in a spacious, comfortable and safe environment. The kitchen is large enough to allow service users to assist in there under staff supervision. There were a few marks and scratches on the walls, even on those, as in the hall, that had been redecorated fairly recently. Some bedrooms now have laminated floors as a way of managing continence issues. Bedrooms include items that reflect service users’ interests; one room had plenty of ‘Elvis’ pictures. Service users have, over time, made their preferences for rooms known, so that, for example, one particular room has become the activity room used almost exclusively by one person, whilst Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 15 particular bathrooms and toilets have tended to become favoured by particular service users. Upstairs rooms had a bar across each window. This prevents them being opened very far, even in emergency. One toilet had no soap dispenser or a towel. The manager advised that these had been targeted by service users in the past, but acknowledged that the home should renew efforts in this respect to encourage good hand-washing practices. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Service users are supported by an effective staff team that is familiar with their needs, through effective recruitment, training, guidelines, and supervision. EVIDENCE: There were sufficient staff on duty to meet service users needs, which varied a great deal within the shift, with service users alternating between wanting activities, and wanting to be on their own. Staff were able to meet these needs and provide for anticipated and spontaneous activities. Rotas showed the home worked with two staff plus a team leader in the morning shift, and four staff plus a team leader in the afternoon/evening shift. Records and discussion with staff and the manager showed staff training was regular and ongoing. The manager advised that all staff were undertaking LDAF training; and expressed concerns about the impact on staff rotas of large numbers of staff being released for training. Regular supervision takes place. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 17 Rotas showed occasional use of agency staff; files showed that satisfactory information, including details of suitable CRB checks, was available. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40,42. The health and safety of service users is promoted by the practices and policies of the home. Proper fire closures on downstairs doors, and a clarification of night time fire procedures will better ensure service user safety. Having person-centred plans in place for all service users will assist in ascertaining and meeting their longer term goals and wishes. EVIDENCE: All required safety certificates were available and up-to-date, including fire certificates. There is a fire evacuation procedure in place; the home is confer with the fire officer in respect of an appropriate fire policy for the night and how this should differ from the day time one. Two doors downstairs used as main thoroughfares were kept open by door wedges that were removed. There is a locked door policy in place in respect of the kitchen. Service users views are seen to be taken into account on a daily basis. Not all service users have person-centred plans. Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 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 3 3 x 2 x E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 20 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 42 Regulation 23(4) Requirement Proper fire door closures/releases must be in place on downstairs doors, so that door wedges are not used. Timescale for action 25/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 21 Good Practice Recommendations It is recommended that a system be devised to readily account for medication provided for outside activities, and that this medication remain foil-wrapped where appropriate. It is recommended that a secure accessible soap attachment is supplied in the bathroom, along with an accessible towel. It is recommended, in consultation with the fire officer, that more appropriate window closures are sought for upstairs windows. It is recommended that, in consultation with the fire officer, that the fire procedure for the night time reflects the different needs and staffing at that time. 2. 3. 4. 27 25 42 Pia - Four Gables E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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 E53 s4280 Pia Four Gables v234616 220605 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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