Inspection on 11/01/07 for Pippin House

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Pippin House 09/02/06

Pippin House 26/07/05

Pippin House 19/10/04

Pippin House 04/05/04

Pippin House 18/09/02

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Pippin House 8 Keyberry Park Newton Abbot Devon TQ12 1BZ Lead Inspector Stella Lindsay Key Inspection (unannounced) 11th January 2007 10:00 Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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 Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pippin House Address 8 Keyberry Park Newton Abbot Devon TQ12 1BZ 01626 354521 01626 360260 rick.godfrey@rnid.org.uk 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) RNID Care Services South West and Wales Richard Godfrey Care Home 8 Category(ies) of Learning disability (8), Mental disorder, registration, with number excluding learning disability or dementia (8), of places Sensory impairment (8) Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Pippin House is a specialist home operated by The Royal National Institute for Deaf People and registered to accommodate people between the ages of 18 and 65. All of the residents are profoundly deaf, but are in residential care due to a range of learning disabilities (including autistic spectrum disorder) and/or mental health problems. The focus of the work undertaken at Pippin House is to enable the residents to achieve their maximum potential, and great emphasis is placed on communicating with them. The home is a detached house in a quiet residential area less than a mile from the town centre. It has a large, secluded garden and a car parking area. Each resident has a single bedroom with his/her own toilet and shower facilities. On the ground floor there is a communal lounge, dining room, conservatory, kitchen, laundry and office. There is no lift and the building is not suitable to accommodate anyone with significantly impaired mobility. There are no bedrooms on the ground floor. Current fees range from £598 - £1559. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a Thursday in January 2007. It involved a tour of the premises, and examination of care records, staff files, health and safety records and the medication system. The inspector met with the Registered Manager, Mr Richard Godfrey, four residents, and four staff on duty. Residents’ relatives and staff members had returned surveys and comment cards to the CSCI, and their views are represented in the text. The Manager had provided supporting information prior to the inspection. All core standards were inspected. The inspector is indebted to the staff for their help in interpreting with the residents. What the service does well: What has improved since the last inspection? Staff were pleased to give the opinion that teamwork had strengthened over the past year, and that staff and residents were working together more positively than ever. Management of Actual and Potential Aggression (MAPA) and Child Protection training had been provided for all staff, to assure continued best practice with regard to management of challenging behaviour and protection of residents and to comply with RNID policy. The lounge and dining rooms had been redecorated, and two bedrooms recarpeted, to maintain a safe and attractive living environment. Residents’ en-suite showers had been renewed, and made easier to use, with lever tap handles. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 6 Work had been arranged in response to the Fire Safety Officer’s advice, with regard to a glazed kitchen door, and hold-open devices for the kitchen, laundry, office and lounge doors, in order to ensure that emergency escape routes would be clear. 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. The summary of this inspection report can be made available in other formats on request. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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 Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good clear information is thoughtfully presented, and thorough assessment required. 1,2,5 EVIDENCE: There has not been an admission since 2003. The RNID has a policy and procedure to make sure that proper assessment is carried out before offering accommodation. It requires that ‘offers of residency’ are to be based on successful introductory visits, a completed care needs assessment, and ‘the home’s expressed confidence that it can meet all of the care objectives identified.’ No emergency admissions would be contemplated. Compatibility with current residents is of prime importance when considering applications. The RNID has produced a new Statement of Rights and Responsibilities in registered care, to clarify for residents and their representatives the terms of their residence, as well as what they can expect with regards to having their care needs reviewed, and their views about the running of the home considered. The Manager at Pippin House received these during the course of this inspection, and the work of communicating them to the residents was about to start. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ care and development needs are discussed with them regularly, and progress is promoted within a risk management framework. 6,7,9 EVIDENCE: Each resident had a full and detailed care plan. The initial Bio data starts with individual communication needs. The care plan is structured to consider areas of need, and the goal and action to be taken in regard to each of these, who is responsible, and if there is any timescale for accomplishment. The areas covered include diet, activities and holidays, the residents agreed responsibility for household tasks, contact with their family, any help needed with personal hygiene and appearance, work towards independence, and whether there is any danger of self-harming. A core meeting is held every three months with each resident. The inspector was pleased to join one that occurred during this inspection, with the resident, their key worker and a Senior Support Worker. The goals were reviewed, along with progress achieved, any concerns and any health issues. The resident clearly enjoyed their activities, and their health had improved since the previous review. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 10 Methods of Approach are being developed by staff for each resident, to specify behaviours that cause concern, and responses that are agreed by the team, to assure effective work and consistency of approach. Residents are helped to manage their money, in order that they may have enough for their daily spending requirements, and also helped to save, if the resident has a goal in mind. The Manager acts as appointee for six residents. Each had their own bank account. Risk assessments had been reviewed regularly. Residents were encouraged to participate in a range of activities according to their own interests and preferences. Additional funding had been obtained so that a resident could be supported to continue swimming for their club in galas across the county. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Pippin House staff are really good at arranging work placements, accessing college courses, and promoting hobbies and leisure activities for the residents. 12,13,15,16,17 EVIDENCE: Residents’ involvement in household tasks is agreed with them and included in their care plan. Residents had been involved in preparing snacks and drinks, and one regularly enjoys baking. Residents help with housework and doing their own laundry. Some are involved in college courses in Independent Living skills. Residents have communication books to take with them to their colleges, to enable messages to be sent between staff. Interests enjoyed by residents and promoted by staff included photography, swimming, baking, gardening and walking. During the inspection, four residents attended college, one was working on a farm, and another joined a walking group in the morning, and had a swim and sauna in the afternoon. One resident has recently started a work placement in a nearby care home, Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 12 which they are enjoying and building up good relationships with colleagues and residents there. Pippin House has a minibus and a car, and residents are encouraged to walk or use public transport, where risk assessment shows this to be safe. A chart shows all regular weekly activities, to ensure that nothing is forgotten, and staff, transport, medication, cash etc are all in place. Spontaneous outings are also frequently provided. A trip to the pub was planned for the evening following this inspection, and there were memories of trips out to Dartmoor, supermarkets, and the beach. A holiday had already been booked, and staff cover arranged, for a trip to Exmoor later in the year. One resident prefers to stay at home, enjoying the freedom and quiet when others are away. Residents have enjoyed family visits, and contact is assisted if necessary, with one resident being taken to London to visit their family. At lunch, a variety of salads were provided, to accompany ham and cheese rolls. Fruit bowls were in the dining room. For supper, there was pizza and salad. Staff added roast potatoes to the menu, and there were also vol-auvents baked by residents. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ health is monitored carefully, and external professional help is requested when necessary. There is a safe medication system. 18,19,20 EVIDENCE: Residents do not generally need assistance with personal care, but such reminders as are necessary are detailed in the care plan. There was evidence in care plans of medical help, routine tests, and medication reviews being obtained as required. All residents are registered with a general practitioner. Health appointments are recorded. The files included a weight chart. Particular advice for staff was included as necessary. For instance, there was advice for staff on guidance for staff on leading partially sighted people. It was advised to lead with the left arm to leave one’s right hand free for signing, and to use a shoulder bag for the same reason. The home’s procedure for administering medication was clearly written, and available for staff. A Senior Support Worker was responsible for overseeing the proper running of the system. All eleven permanent staff had received training in dealing with medication. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 14 None of the current residents was deemed able to self-administer reliably. An allocated worker administers medications, and the records are checked by the Senior at the end of each shift, as a self-monitoring system. Some residents were sufficiently overweight for this to have an effect on their health and well-being. Staff were aware of this, and all sorts of activity and exercise were encouraged. Healthy food was provided. However, if weight management is to be successful, there needs to be a consistent approach throughout the 24 hours. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are protected by staff awareness and effective communication with residents. 22,23 EVIDENCE: The complaints procedure is displayed in the hallway, produced with pictures and symbols to help residents to understand. Residents can rely on the vigilance and good skills in observation of the staff and management to assure their safety. The Manager keeps a hardbacked book to record any complaints. The CSCI had not received any complaints. The two received by the Manager had been made by residents, about the behaviour of another resident. Staff have been trained in the Management of Actual and Potential Aggression (MAPA). The home has introduced and is developing Methods of Approach for each resident to advise staff on individuals’ triggers to disturbed behaviour, and effective ways of improving or ameliorating situations. Staff had received training in the Protection of Vulnerable Adults, and also in Child Protection, in line with RNID’s policy. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pippin House is comfortable and homely and with the appearance of a family house. It was clean and hygienic. 24,26,30 EVIDENCE: The home is in an attractive residential area and is set back down a drive, which gives a secluded and safe feeling. It has a large garden (with greenhouse) and a sizeable car parking area. There is a plan for maintenance and improvement, including plans to improve the accessibility of the building. The communal rooms are comfortable and quite spacious. The garden had been used for barbeques, and vegetables provided for the table. Three bedrooms were seen, all attractive and filled with things the residents need to pursue their interests, and all with computers. It was clear that these occupants were pleased with their rooms, and had chosen colour schemes and fittings. The large windows gave excellent natural light. Each of them has his/her own toilet and shower facilities. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 17 The house was clean throughout. The floor needing renewal was booked for the laundry, and the hazardous part obscured. The hallway and stair carpets awaiting replacement had no safety problems, but would benefit from renewal. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Competent, caring and well-motivated staff are employed in sufficient numbers to provide sensitive care and opportunities for the residents at Pippin House. 32,34,35 EVIDENCE: Staff levels were seen to be sufficient to care for the residents, to give attention as required and enable them to take part in individual activities in the local community. At night a staff member remains on sleeping-in duty, and another on-call in case of emergency, which had not been needed for 18 months prior to this inspection. The staff were well motivated, and all spoke of good teamwork and joint working to improve the life of the residents. Staff are trained in Basic British Sign Language (BSL). All staff are encouraged to attain NVQ3, and at the time of this inspection two staff had achieved NVQ4, two had NVQ3, two had NVQ2, while two more were engaged in NVQ training. Three staff were qualified NVQ assessors. Training provided in the past year for all staff included medication, risk assessment; MAPA; and child protection. Staff had also benefited from Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 19 training in conflict resolution, mental health, autistic spectrum disorders and food hygiene. The staff group is stable, with few changes, which is vital for this client group on account of their communication needs. The files of two more recently appointed staff were examined, and found to have the documents required to show that checks had been carried out to assure the residents’ safety. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of its residents, and the quality and safety of the service audited systematically. 37,39,42 EVIDENCE: The Registered Manager of Pippin House, Mr Richard Godfrey, has NVQ4 in Care and many years of experience in managing residential care for this client group, having worked for the RNID since 1988. He leads the team vigorously, upholding the rights of residents and supporting staff in their efforts to provide a good quality of life for the residents. Staff meetings are held fortnightly. Staff told the inspector they feel able to raise issues freely. Minutes for the past two meetings showed that topics discussed ranged from health and safety matters, and Methods of Approach for one resident, and up-dates for all, to Christmas arrangements. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 21 The home’s performance with regard to all National Minimum Standards are considered in turn at staff meetings, and by the Residential Services Manager in his monthly visits to the home. Communicating with residents and helping them to express themselves is a central focus of this service. In addition to everyday discussion, the home has produced questionnaires with photos, symbols, and very clear writing to give an opportunity for residents to express views on their room, the food, staff, health care and activities at Pippin House. Monthly residents’ meetings are held, to make sure residents do not miss out on news and information. The Residential Services Manager, South West & Wales, has been visiting Pippin House monthly to audit the service and check that National Minimum Standards are being met. He lists action to be taken, and sends full reports to the CSCI. The Manager is working on plans to develop the premises to provide greater scope for independent living for those who wish to progress in this way. The needs of residents as they grow older and may have reduced mobility are also being considered by management. Work had been arranged in response to the Fire Safety Officer’s advice, with regard to a glazed kitchen door, and hold-open devices for the kitchen, laundry, office and lounge doors. Fire training had been provided on 03/01/07, and all staff trained – except the Manager. The trainer was a former Fire Officer who was familiar with Pippin House, which added focus to the training. Fire drills are held weekly. The fire precaution system had been checked professionally on 29/08/06, and was checked as part of the installation of the magnetic hold-open devices, which are linked to the main system. Nine of the eleven permanent staff were qualified First aiders. Training or updates had been provided for four, in the effort to maintain a first aider on duty at all times. A risk assessment should be carried out with respect to any window above ground level which opens wide, and to which residents may have access, in order that a restrictor might be fitted if any risk is found to be present. The temperature of hot water in baths and showers should be checked weekly, to ensure that the thermostatic valves are working properly to prevent any risk of scalding. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 3 X Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 23 There were none. 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. Standard Regulation Requirement Timescale for action 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 YA42 YA42 Good Practice Recommendations Temperature of hot water in baths and showers should be checked periodically. Window restrictors should be provided, based on assessment of residents’ vulnerability and any perceived risk to them. Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Pippin House DS0000003776.V310953.R01.S.doc Version 5.2 Page 25 - 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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