CARE HOME ADULTS 18-65
Pinehaven 23 Parkwood Road Boscombe Bournemouth Dorset BH5 2BS Lead Inspector
Stephanie Omosevwerha Unannounced Inspection 7th September 2005 16:30 Pinehaven DS0000003946.V248957.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 Pinehaven DS0000003946.V248957.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. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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 Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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. 8th March 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. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place during the evening between 16.30 and 21.30. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI and to address the requirements and recommendations made at the previous inspection. The manager was available throughout the inspection and the inspector had the opportunity to look at some records and documentation e.g. risk assessments, recruitment information and medication records. The manager provided additional information after the inspection including information on staff training and further risk assessments. The rest of the inspection was spent talking to the service users both on an individual and collective basis. All communal areas of the home were viewed and 1 resident showed the inspector his bedroom. The inspection took into account previous information sent to the inspector by the responsible individual including copies of a draft statement of purpose, service user guide and contracts and policies and procedures including the complaints procedure. The inspector receives regular monthly reports from the responsible individual about this service that are available to provide additional information for the inspection. What the service does well:
Pinehaven works in a person centred way focusing on each resident’s individual goals and aspirations. There are many examples of how their choices and decisions are supported including choices of daytime activities, social and leisure pursuits, personal relationship and finances. Service users are given excellent opportunities to develop skills and several residents were keen to tell the inspector how they were working towards independent living. This included having their own food budget and doing their own shopping. The daily routines further promote choice and flexibility and this is evident at meal times when service users fully participate in meal preparation and are able to choose what they want to eat and where they want to eat it. Service users benefit from a creative and encouraging management style, which gives them opportunities to develop and progress their aspirations. Staff within the organisation have good access to training and a high level of interaction between staff and residents was observed and it was evident that positive relationships had been formed. 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. A comprehensive and accessible complaints procedure contributes
Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 6 to this ethos of openness. Pinehaven has a comfortable and inviting environment and service users enjoy the relaxed atmosphere. They told the inspector they can invite visitors and a variety of social contacts are promoted including overnight stays if appropriate. 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. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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 Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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): 2. The home has a clear admissions procedure, which focuses on obtaining a detailed assessment involving the service user, their family, social worker and other relevant people to ensure service users’ needs can be met. EVIDENCE: Prior to the inspection the Responsible Individual sent the inspector an updated policy on admissions – “Joining SFHT – Assessment”. The policy stated “the assessment is a way of determining the level of support the person needs and whether their needs can be met within the service.” It also set out the assessment process that included gathering information such as community care assessments and other relevant reports and discussion with the service user, family, social worker and any other relevant people. This ensured that a comprehensive procedure was in place to ascertain whether the service could meet the needs of any prospective service user. In addition, the inspector was provided with additional information included an updated Statement of Purpose, Service user guide and contract. Although all these documents are still in draft format, they were produced to a high standard providing detailed information about the organisation and the home. There had been no new admissions to the home since the previous inspection when it was established that residents were only admitted on the basis of a full care management assessment. Residents expressed a great deal of satisfaction with their care and most had clear goals that they were working towards, e.g. gaining skills to move into more independent accommodation.
Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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): 7. Service users choices were promoted meaning service users were confident about making decisions about their lives and receiving support and assistance when it was needed. EVIDENCE: Throughout the inspection there were various examples of how service users made decisions about their lives. These included choosing to spend time in the privacy of their rooms or the communal areas of the home, choosing what they ate, some service users have their own food budgets and purchase their own food, choosing the social activities and holidays they wish to go on. Service users were confident about expressing their choices and it was evident in discussions with residents that they were supported in the decisions they made about their lives e.g. decisions about important personal relationships and future plans. Residents confirmed they were aware of local advocacy schemes. The manager had approached a local advocacy group who had met with all the service users and could be approached at any time if a resident needed this service. One service user was a trustee for a local advocacy scheme and had undertaken training to fulfil this role.
Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 10 All service users have individual bank accounts and their finances are managed according to individual care plans, i.e. some service users manage independently whilst others need support from staff. The inspector saw an example of a risk assessment that have now been completed to determine each service users’ ability to manage their finances particularly with regard to using community facilities such as cash points. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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): 15, 16 and 17. The home makes visitors feel welcome and offers service users excellent support with their personal relationships enabling them to develop healthy social lives and maintain strong family ties. The home’s daily routines promote service users’ rights, choices and independence and resident’s responsibilities are clearly recognised and understood. The home offers maximum choice and flexibility over meal times with service users fully participating in all aspects of menu planning and preparation. EVIDENCE: The manager confirmed visitors are welcomed into the home and can stay overnight if this is the resident’s choice. The organisation has a policy on Personal Relationships and service users are given support and advice on this subject. Residents confirmed they could have visits and described a range of social contacts e.g. going to stay with relatives, family can visit for meals, meeting up and having dinner out and partners/family staying the night in the
Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 12 home. They also told the inspector they could have regular phone contact with family and friends. During the inspection service users were observed to have unrestricted access to all communal areas of the home. Responsibilities for household tasks were clear and these were discussed at residents’ meetings and a rota was displayed on the notice board confirming everyone’s agreed responsibilities. Service users had keys to their bedroom doors and told the inspector they were responsible for looking after their own bedrooms. One service users was observed cleaning the kitchen floor area in her bedroom during the inspection. Further terms and conditions are clarified in service users contracts e.g. “you will be expected to keep your room in good condition”. The majority of service users have their main meal provided at the day service from Monday to Friday. A record of meals provided at the centre was maintained at the home. Some service users have their own food budget and purchase food of their choice, which they then prepare in their rooms. Residents have now agreed to have meals together on a Wednesday, Saturday and Sunday. The rest of the time they either prepare their meals independently or with staff support according to individual care plans ensuring they have maximum choice and fully participate in meal preparations. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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): 20. The administration of medication in the home was satisfactory, although further reorganisation of the medication cupboard would enhance the current procedures, simplifying the process for the staff. EVIDENCE: The medication cupboard and records were observed as part of the inspection. Some improvements were noted, i.e. the removal of duplicate medication and medication that was no longer prescribed. The inspector recommended that prescribed and non-prescribed medication was kept separate as well as nonmedication items such as hearing aid batteries. This would assist staff when giving out prescribed medication and make it far less likely that mistakes might be made. It was also recommended that a list of service users current medication be kept with the records of administration, as although these records were available they were currently kept in a separate file. It is important that this information is readily available to staff when they give out medication so they can check what they are administering is correct. One resident is currently self-medicating and the inspector saw an appropriate risk assessment. All records checked were up-to-date and accurate. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 14 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): 22. There is an ethos of openness throughout the organisation and service users were confident about how to raise complaints feeling their views would be listened to and acted upon. EVIDENCE: The responsible individual sent the fully up-dated complaints policy and procedure to the inspector prior to the inspection. The policy is clear offering comprehensive guidance to staff about dealing with minor complaints and more serious ones. There is a clear line of accountability throughout the organisation and information is given about other agencies that can be approached including CSCI. An accessible format has been developed for service users called “Making things better”. This includes a simple written format and symbols to explain the procedure and a form that the service user can complete with appropriate support if necessary e.g. an advocate. Service users confirmed they were fully aware of the procedure and how to use it. The also were confident that any issues/problems raised would be resolved by the organisation, although they did know they could talk to other agencies such as social services and CSCI if necessary. It was noticeable that the organisation encourages an ethos of openness and “welcome complaints as they can bring something wrong with the service to our attention and enable us to improve what we do”. The home has a separate complaints procedure for anyone other than service users. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 15 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. The home offers residents an environment that is comfortable, inviting and homely and residents enjoy the relaxed atmosphere that this creates. EVIDENCE: All communal areas of the home were seen as part of the inspection. This included the lounge, dining room, kitchen, quiet room and conservatory area. All areas are comfortable, homely and inviting and observation throughout the inspection demonstrated all spaces were fully accessible to service users. Individual privacy was respected and service users could choose whether to spend time alone in their rooms or join the group in the communal areas. The manager told the inspector there were future plans to enhance the living environment including plans to extend the kitchen into a kitchen dining area making use of the existing quiet room and turning the dining room into an activities room. There were also plans to enhance the external appearance by re-painting the front and replacing windows. Work had already been undertaken in the garden to make this more user friendly. During the inspection one service user showed the inspector his bedroom. This was clearly personalised decorated in the colours of his favourite football team
Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 16 and had sufficient space for all his personal possessions. Discussion with residents confirmed they were happy with the facilities offered by Pinehaven and enjoyed the relaxed atmosphere of the home. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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): 33, 34 and 35. Service users have benefited from an increase in staffing in the home giving them more choice about their daytime, social and leisure opportunities. The home has a thorough and inclusive recruitment procedure that gives service users the opportunity to participate in staff selection. Some gaps in records mean it is not possible to ascertain that robust recruitment procedures are followed through although discussion with the manager indicates all necessary checks are carried out to ensure the safety of service users. The standard of training provided is good and linked to the individual and joint needs of service users. EVIDENCE: The home is now fully staffed and has recruited some new staff since the previous inspection. The inspector was shown evidence of the current recruitment procedure that included application forms, an interview questionnaire that was scored and a set written piece. Service users were included on the interview panel and spoke about this during the evening, e.g. one resident who was hoping to move on into supported accommodation told the inspector she had been interviewing staff who would potentially support her in the future. The manager said potential new members of staff were also invited to spend time in the home to observe how they interacted with the residents and gain feed back from the service users. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 18 Complete staff records were not available to see during the inspection. Staff records are held at the head office of the SFHT and an agreement now needs to be set up with the organisation about future access to these in accordance with the revised CRB guidance. All new staff begin an in-house induction that has just been up-dated corporately. They then move on to a foundation course that is LDAF accredited. The SFHT has a designated training officer who is responsible for co-ordinating and arranging training. Records showed staff had undertaken a range of courses including health and safety, fire training, medication management, manual handling, food hygiene and protection of vulnerable adults as well as more specialised training such as Makaton to ensure staff could communicate effectively with service users living in the home. Staff also had the opportunity to undertake NVQ training and one member of staff had achieved NVQ3. There had been staff changes, however, with 3 new staff members staff which had reduced the number of staff achieving NVQ2 in the home. The staffing rota was analysed and showed that one member of staff was on duty from 7.00 – 9.00 am and two members of staff from 5.00 – 10.00 pm with one member of staff sleeping in. At the weekends there were 2 members of staff on duty all the time. The manager had also managed to increase staffing levels every other weekend to provide a third member of staff on a Saturday and Sunday for 3 hours to give residents further social/leisure opportunities. The home was also now staffed during the day on a Monday – Thursday giving residents more choice about what they did during the week. This meant some service users were spending more time in the home with one-to-one support if this was appropriate for their changing care needs. The manager said the home would be staffed during the day on Fridays as well commencing in October. Service users said they like the staff and that they were approachable. Observation throughout the inspection showed that positive relationships had been formed and service users were treated with a great deal of respect and genuine care. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 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. Service users benefit from a creative and encouraging management style, which gives them opportunities to develop and progress their aspirations. EVIDENCE: The manager at Pinehaven is experienced and has completed his NVQ4 in management. He is in the final stages of completing NVQ4 in care and is on track to finish this by the end of the year. The manager demonstrates a commitment to improving quality of care in the home based on the views of service users living there. Observation throughout the inspection demonstrated service users being able to approach the manager who has created an open and inclusive atmosphere in the home. Through the leadership skills communicated all service users are able to develop and progress and have ‘real’ opportunities to work towards their goals and aspirations, e.g. service users are working towards more independent living and future moves are being planned and supported. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 20 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 Score 4 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 4 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Pinehaven Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X X X DS0000003946.V248957.R01.S.doc Version 5.0 Page 21 Yes 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 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. Timescale for action 01/12/05 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 YA20 Good Practice Recommendations It is recommended that all prescribed medication, nonprescribed medication and other non-medication items such as hearing aid batteries are kept separately to avoid the possibility of errors being made. It is recommended that a list of current medication is kept in the medication file to ensure ease of reference for staff administering medication. It is recommended that the registered provider should produce a written policy and procedure concerned with the recruitment of staff. 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.
DS0000003946.V248957.R01.S.doc Version 5.0 Page 22 2 3 4 YA20 YA34 YA36 Pinehaven 5 YA40 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 standard was not assessed on this occasion but carried forward from the previous inspection. Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 23 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
© 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 Pinehaven DS0000003946.V248957.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
