CARE HOME ADULTS 18-65
Pinehaven 23 Parkwood Road Boscombe Bournemouth Dorset BH5 2BS Lead Inspector
Stephanie Omosevwerha Unannounced Inspection 27th February 2006 15:30 DS0000003946.V283338.R01.S.doc Version 5.1 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 DS0000003946.V283338.R01.S.doc Version 5.1 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. DS0000003946.V283338.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Pinehaven Address 23 Parkwood Road Boscombe Bournemouth Dorset BH5 2BS 01202 427941 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) The Stable Family Home Trust Mr Michael Nigel Pickford Care Home 9 Category(ies) of Learning disability (9) registration, with number of places DS0000003946.V283338.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service user to be accommodated in the second floor room must not be dependent on staff for means of their escape in the event of a fire. 7th September 2005 Date of last inspection Brief Description of the Service: The registered service provider is The Stable Family Home Trust [S.F.H.T] a registered charity that provides residential care, a day service and related services for adults with learning disabilities. The day and residential services are interdependent with support from specialist staff at the day service being available to the staff and service users in residential care services to provide training, guidance and help with among other things, issues such as employment; risk assessments and personal relationships. Pinehaven is a detached house converted for use as a residential care home, located in the residential area of Southbourne, fairly close to the cliff top and beach. It is within walking distance of the shopping areas and local amenities of Southbourne and Boscombe. There is good access to public transport including the railway station at Pokesdown. The accommodation provides for 9 adults and all service users have single bedrooms, which are located on the ground, first and second floor. Communal facilities include a lounge, dining room, kitchen, activity room and conservatory area. Outside there is a garden at the rear of the property and a tarmac area to the front that provides off road parking. DS0000003946.V283338.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned inspection programme for care home undertaken by CSCI. The home was given no prior warning of the inspection, which took place over 5 hours during the evening when all the service users were home. The manager was available throughout the inspection and the inspector had the opportunity to look at some records and documentation such as residents care plans, health records, risk assessments, medication records and some policies and procedures. The inspector also spoke to one member of staff. The rest of the inspection was spent talking to residents both on an individual and collective basis. All communal areas of the home were viewed and one service user’s bedroom. The inspector also took into account the regular monthly reports that are sent to CSCI by the responsible individual of the home. What the service does well:
Pinehaven benefits from a creative and encouraging management style, which gives residents opportunities to develop and progress their aspirations. The home achieves excellent outcomes for the service users living there and there are good examples of how residents have been able to move on and accomplished new skills promoting their independence. The home works in a person centred way giving service users real choices and helping them take control of their lives. The home takes a proactive role in risk assessments using them to help service users gain new skills rather than placing unnecessary restrictions on them. All service users have opportunities to undertake educational and social activities and there are excellent links to the local community with residents making good use of local shops and amenities. Service users are also given opportunities to make a real contribution to the home and an example of this included one service user who had taken control of the home menus, drawing up a weekly list based on other residents likes and dislikes. They were then able to help with the weekly shop purchasing the home’s requirements. The home has a committed and enthusiastic staff team who work hard to improve the service users quality of life. A good rapport was observed between the care staff and service users and it is clear that they have an excellent knowledge of service users care needs. DS0000003946.V283338.R01.S.doc Version 5.1 Page 6 The home has an open and inclusive atmosphere and service users are encouraged to voice their opinions. It was evident in discussion with service users that they are confident in expressing their views and feel they are listened to. Service users spoke positively about the home and their care and told the inspector they enjoyed living there. 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.
DS0000003946.V283338.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection DS0000003946.V283338.R01.S.doc Version 5.1 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 the following standard(s): The key standard was assessed and met at the previous inspection. EVIDENCE: DS0000003946.V283338.R01.S.doc Version 5.1 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 the following standard(s): 6 and 9. The home have adopted a person centred approach to care planning and in practice staff have a clear understanding of service users care needs and residents are well supported in achieving their personal goals. This is not always reflected in service users written plans, which would benefit from containing clearer guidance to staff about residents support needs. The home has a good system of risk management, which is based on encouraging service users to take responsible risks rather than restricting their independence. EVIDENCE: The home has adopted a person centred approach to care planning and an example of one resident’s file was shown to the inspector. There was clear evidence of service user participation in the process as the service user had filled in their own plan. The plan contained detailed information about the service users likes and dislikes and their goals and aspirations, e.g. “I would like to go out on my own”. Discussion with the manager and service user clearly evidenced that this was being implemented in practice with the service user being supported by a
DS0000003946.V283338.R01.S.doc Version 5.1 Page 10 member of staff to become more independent in the community, however, there was limited information recorded about how the home was going to support service users meeting their goals. Most of the service users at Pinehaven are able to articulated their needs and told the inspector that they felt well supported in the home. They confirmed they were aware of their plans and felt they were encouraged to pursue their goals by the care staff. There was further evidence that service users were being supported in achieving their goals as the inspector was told one resident had successfully moved out into more independent accommodation. Whilst the inspector acknowledged that it is good practice to adopt a person centred approach, the home needs to ensure support needs are recorded more clearly in care plans giving staff clearer guidance on how to work with the residents. This would be particularly important if service users had more difficulty in communicating their care needs to members of staff. Service user had signed written evidence that any potential limitations had been discussed with them and appropriate agreements had been reached. Examples of these included management of money and boundaries concerning behavioural issues. The home has a risk management framework in place and the inspector examined a number of risk assessments that relate to individual service users. There was evidence that a number of risks had been considered such as domestic activities, accessing the community, managing finances and medication. There was evidence that this process was regularly reviewed increasing service users opportunities to learn new skills. For example the service user who was working towards independence in the community was currently being risk assessed by a member of staff to ensure the service user was able to achieve this task safely. DS0000003946.V283338.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13. All service users are engaged in appropriate activities and have been offered increased choice about what they do in the daytime by providing alternatives to attending the SFHT day services. Service users have good links to their local community, which supports and enriches their social and educational activities. EVIDENCE: All service users take part in activities outside the home. Most service users attend the day service managed by the S.F.H.T., although there are now more opportunities for service users to make choices during the day. This means that the home is able to provide some staffing during the day so service users can stay home and undertake activities such as home skills, budget skills, walking/gentle exercises and attending activities in the community such as art, watercolours, bingo and pottery. The day service also provides a range of activities and individuals are also supported to find work experience such as working in a coffee shop or charity shop. Service users told the inspector they were happy with the activities provided.
DS0000003946.V283338.R01.S.doc Version 5.1 Page 12 There was evidence that service users were able to access the community on a regular basis. Service users talked about going out to the local shops and other local amenities. The home is a short level walk from the local shopping centre and has good access to public transport routes. Observation throughout the inspection also showed that one service user had been to a local supermarket to do some food shopping for the home supported by a member of staff and another service user went to the bank and newsagents to buy a magazine they were collecting. DS0000003946.V283338.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users are encouraged to have control over their personal support and their independence is promoted. The healthcare needs of service users are well met with evidence of good multi disciplinary work taking place on a regular basis. The home has improved the organisation of medication ensuring this is managed more effectively promoting service users’ good health. EVIDENCE: The majority of service users at Pinehaven can manage their personal care independently with staff providing advice and prompting when necessary. Discussion with service users confirmed their personal care needs were met and they were comfortable asking for assistance from staff who treated them with respect. There was evidence that staff encouraged service users to maintain independence and control and a good rapport was observed between staff and service users. The inspector noted that personal care needs were not always clearly documented in service users care plans and recommended that clearer guidance on support needs was available to members of staff. This would be
DS0000003946.V283338.R01.S.doc Version 5.1 Page 14 particularly important if service users were not able to articulate their care needs clearly. Service users health care needs were noted in their personal health records (yellow books) that were seen by the inspector. These contained information about service users physical and emotional health, as well as details of their current medication. Visits to healthcare professionals were recorded such as dentists, opticians and hearing tests and there was evidence these were being carried out on a regular basis. There was also evidence of liaison with other professionals such as the community nurse who had written comments in the service users healthcare record. The home had also liaised with healthcare professionals for advice when setting up plans to manage behaviour e.g. one service user was currently on a programme based on a system of merits and warning, which had been set up in liaison with their Doctor. Some recommendations were made at the previous inspection regarding the reorganisation of the medication cupboard and the recording of current medication on the medication files. The medication cupboard and medication file were checked as part of the inspection and significant improvements were noted making the process of administrating medication much simpler for staff and avoiding the likelihood of any errors being made. DS0000003946.V283338.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. There is clear guidance and training in place for staff concerning the protection of vulnerable adults ensuring service users welfare is safeguarded in the home. EVIDENCE: The home has a number of policies concerning with the protection of vulnerable adults and these were made available to the inspector. These included Adult Protection and Dealing with Abuse, Personal Relationships and Sexuality, Bullying in the Workplace, Acceptance of Gifts and Financial Procedures. Discussion with the manager confirmed his awareness of adult protection procedures and staff also receive training in adult protection and dealing with challenging behaviours. DS0000003946.V283338.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30. The home is kept clean and hygienic with systems in place to ensure service users are protected from spread of infection. EVIDENCE: On the evening of the inspection the home was observed to be lit, warm, clean and tidy. The inspector was shown the home’s policy for infection control that contained guidance to staff about cleaning, spillages and clinical waste. There was further information and procedures for communicable diseases. The home has a separate laundry room that is sited away from areas where food is stored, prepared, cooked or eaten and is appropriate for the resident’s needs. The manager said that most residents know how to operate the washing machine and carry out their own laundry with staff support as necessary. DS0000003946.V283338.R01.S.doc Version 5.1 Page 17 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): 32 and 34. The home benefits from an enthusiastic and motivated staff team who work positively with service users to improve their quality of life. The home needs to demonstrate that safe recruitment procedures are being followed to ensure service users are protected in the home. EVIDENCE: There had been some changes in the staff team since the previous inspection, which has affected the number of qualified staff in the home. There are currently two members of staff who hold a level 2 NVQ qualification or above and a further 3 members of staff are currently undertaking a NVQ or equivalent qualification. There are 2 new members of staff joining the staff team. This means the home does not currently meet the target of 50 of staff holding a NVQ 2 qualification or above, however, there is evidence that the home is working towards achieving this target. The inspector had the opportunity to speak to one member of staff who demonstrated a good knowledge and understanding of the residents’ individual and collective needs. Observation of practice showed there was a high level of interaction between staff and service users and it was clear positive relationships had been formed. Service users told the inspector they liked the staff and felt they were approachable.
DS0000003946.V283338.R01.S.doc Version 5.1 Page 18 There was a requirement made at the last inspection concerning access to staffing records. These are not currently available in the home and are kept at the SFHT head office. This means the inspector was unable to verify if a robust recruitment procedure was followed. An agreement needs to be set up with the SFHT about future access to personnel records and this is still outstanding. There is also an outstanding recommendation that the registered provider should produce a written policy and procedure concerned with the recruitment of staff. DS0000003946.V283338.R01.S.doc Version 5.1 Page 19 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, 40 and 42. Service users benefit from a creative and encouraging management style, which gives them opportunities to develop and progress their aspirations. The home encourages feedback about the quality of service from the residents and staff but needs to include this in a formal plan setting out aims and objectives for future service development. The home has yet to fully develop all its policies and procedures to establish a corporate identity and ensure staff have consistence guidance throughout the organisation Practices in the home generally promote and safeguard the health, safety and welfare of the residents; however, fire records need to demonstrate staff receive appropriate training. DS0000003946.V283338.R01.S.doc Version 5.1 Page 20 EVIDENCE: The management of the home was assessed at the last inspection; however, the manager was in the final stages of completing his NVQ4 in management and care. The inspector checked to see if this had been completed. Unfortunately, although he had done all the work, the organisation that was responsible for assessing the work had gone into receivership and therefore, his work had not been verified. An extension to the timescale of December 2005 was agreed in order that this could be sorted out. The manager has set up a simple quality assurance system to monitor certain aspects of care provided and the inspector was shown a questionnaire that had been given to all residents to complete in November 2005. A plan now needs to be produced based on the views of the service users, staff and other interested parties to review the quality of its service and set out future aims and objectives. The manager reported that he also has to make regular monthly reports to the trustees of the SFHT. The responsible individual undertakes regular monitoring visits and monthly reports are sent to the Commission detailing the outcome of these (Regulation 26). There was a previous recommendation for the registered provider to produce written policies and procedures for all the topics set out in Appendix 2 to the National Minimum standards (2nd Edition). The manager showed the inspector some of the new policies that had been produced included one on Personal Relationships and Sexuality and one on Service Users Rights. There are still some outstanding gaps such as the policy on staff recruitment, so this recommendation is carried forward. Records showed that the home was meeting the requirements of other agencies such as Dorset Fire and Rescue Service and Environmental Health Department. Certificates were in place demonstrating that equipment and facilities were regularly serviced and maintained. The home has a basic health and safety policy and this is being updated by the director to make it more comprehensive. Risk assessments had been completed for each room in the home. Records are maintained evidencing the home carries out checks for example fire precautions log book, water temperatures and fridge/freezer temperatures. The home is not currently recording staff fire training although the inspector was told this regularly takes place at the SFHT. This needs to include formal training twice a year and further informal training. The manager confirmed his awareness of relevant legislation and staff had attended various training courses in safe working practices. The accident book was seen and there had been 2 accidents recorded since the last inspection involving service users. DS0000003946.V283338.R01.S.doc Version 5.1 Page 21 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 Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 2 X 2 X DS0000003946.V283338.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 YA34 Regulation 19 Requirement The SFHT must set up an agreement with CSCI regarding future access to personnel records as specified in the revised CRB guidance. (Previous timescale of 01/12/05 not met.) The registered manager needs to complete NVQ 4 in management and care. The registered provider needs to develop a plan based on the views of the service users, staff and other interested parties to review the quality of its service and set out future aims and objectives Timescale for action 01/06/06 2 3 YA37 YA39 9 24 01/07/06 01/06/06 DS0000003946.V283338.R01.S.doc Version 5.1 Page 23 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 YA6 Good Practice Recommendations It is recommended that care plans contain clearer guidance about how staff are to meet service users care needs and support them to achieve their goals and aspirations. (See also Standard 18 – personal care needs). It is recommended that staff should have an NVQ2 or equivalent qualification in care. It is recommended that the registered provider should produce a written policy and procedure concerned with the recruitment of staff. This recommendation is repeated from the inspection reported dated 07/09/05. It is recommended that a system of annual appraisals for staff be reviewed corporately to ensure consistency across the organisation. This standard was not assessed on this occasion but carried forward from the previous inspection. It is recommended that the registered provider should produce written policies and procedures for all the topics set out in Appendix 2 to the National Minimum Standards (2nd Edition). This recommendation is repeated from the inspection report dated 20/12/04). It is recommended that formal fire training should take place twice a year. The training content should be recorded and staff should sign to show they attended. Informal training should also take place with scenarios introduced. 2. 3. YA32 YA34 4. YA36 5. YA40 6. YA42 DS0000003946.V283338.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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