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Inspection on 27/09/07 for Point House

Also see our care home review for Point House for more information

This inspection was carried out on 27th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOME ADULTS 18-65 Point House 2 Sprowston Road Norwich Norfolk NR3 4QN Lead Inspector Mr Jerry Crehan Unannounced Inspection 27th September 2007 12:50 Point House DS0000027360.V351920.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 Point House DS0000027360.V351920.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. Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Point House Address 2 Sprowston Road Norwich Norfolk NR3 4QN 01603 427249 01603 427249 sarah@pointhouse.uk.com www.pointhouse.uk.com Mr Aubrey Cropley Mrs Carol Cropley Miss Sarah Jane Cropley Care Home 22 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) Category(ies) of Learning disability (22), Learning disability over registration, with number 65 years of age (5) of places Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3rd November 2006 Brief Description of the Service: Point House is a care home offering accommodation for up to 22 adults with learning difficulties. The home is situated about 1 mile from the centre of Norwich and is close to many amenities. There are local shops and a regular bus service to the city. The home has bedrooms on both the ground and first floor with easy access to bathroom/shower facilities. There is a car parking area at the front and side of the property with a paved patio at the rear of the property. Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. Four comment cards were received from relatives of people who use the service. These reflected good views about the home and the service it provides to people who live there. Two comment cards were received from people who live at the service, again reflecting positively about the service, this was also reflected by positive comments made by people at the time of the inspection. Records held by the Commission and previous inspection reports were checked. This key inspection comprised an unannounced visit to the home that took place over just more than 6 hours on 27th September 2007. Opportunity was taken to tour the premises, look at care records and policies, observe care delivery to people who use the service, communicate with people who use the service, speak with care staff and the Manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The range of fees for the home is from £490 per week, with additional charges for day care provision. What the service does well: • • Care files reflect the views and aspirations of people who use the service, and they are completed and reviewed with their involvement. The majority of relatives of people who use the service and visitors say that the home generally provides a good service, and that staff are helpful. People who use the service say the home provides a good service to them and that staff are helpful. The home generally achieves a balance between providing people who use the services with freedom of choice in aspects of their lives, whilst considering relevant safety or risk factors for the service user and for others. The home manages to cater well for the lifestyle preferences and diverse needs of its service user group. • • Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 6 • • A high proportion of care staff at the home has achieved a qualification at NVQ level 2 or above. There is a registered manager who is qualified and experienced, and well thought of by people who use the service. What has improved since the last inspection? • There is clearer information available to prospective service users and their families so that they can make informed choices about their choice of home. Environmental risk assessments are in place that address individual wishes of service users and consider wider safety issues that may result. The home has achieved a good ratio of NVQ qualified staff. • • What they could do better: • The manager must ensure that all care plans and risk assessments clearly indicate the care, treatment and supervision required by the service user. A requirement has been made that the manager ensures records of medication stock ‘carried over’ are kept each month in order that accurate audits can be carried out. These audits can then demonstrate, over time, whether medicines have been administered in line with prescribed instructions. A requirement has also been made that the Manager ensures risk assessments that are carried out at the home assess the safety of arrangements for any service users who look after their own medication. This should consider the safety of the service user who looks after and self-administers their own medication, and the safety of other service users at the home. • • 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. Point House DS0000027360.V351920.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 Point House DS0000027360.V351920.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): 1&2 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is available to prospective service users and their families. Service users needs are assessed by a competent person before admission; however, improvements are needed in the way information from the assessment is used as part of care planning to meet individual needs. EVIDENCE: The home’s ‘Statement of Purpose’ has been updated to reflect services available to prospective service users, and this document is available at the home. The document contains all of the information required by regulation. The previous version omitted the size of rooms in the home, the fire precautions for the home and the home’s procedure for dealing with complaints (including timescales). Assessments (including pre-admission assessment) for recently accommodated service users were in evidence and were satisfactory. The assessment for a service user included objectives such as community presence, involvement in day-to-day tasks, activities of choice, safe and secure environment, healthy and balanced diet, and physical and mental health. However, one assessment looked at that considered important aspects of their behaviour history was not referred to accurately in their Point House care plan. The manager indicated that she is now undertaking all pre-admission assessments herself and has been in the process of reviewing those she had not undertaken. Point House DS0000027360.V351920.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): 6, 7 & 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involved in decisions about their lives, and play a role in planning the care and support they receive within their capacities. Some improvements should be made in care planning to ensure staff have the information to know the support that is needed by the people living at the home. EVIDENCE: Several care files were looked at during the site visit. Each contained detailed care plans and risk assessments. There was evidence in care files of a range of risk assessments relative to service users individual needs and aspirations. Care files and discussion with service users provided evidence that if people wish to they can participate in their care planning, their reviews and their individual goal setting, for example losing weight or achieving greater independence in managing their own personal care. Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 10 Information from the returned comment cards from people living at the home indicate that they are satisfied with care provided by staff at the home. People spoken with at the visit confirmed that they are able to make decisions about their lives. Examples given included comments that ‘I can have my own cat’, ‘I can go out when I want’, ‘I can help with my own laundry’. A range of appropriate risk assessments was seen on service users files. These generally achieve a balance between providing service users with freedom of choice in aspects of their lives, whilst considering relevant safety or risk factors for the service user and for others. Comment was received prior to the site visit from community social care professionals who complimented the service on achieving continuity of care for service users and managing some difficult aspects of behaviour (including self harm), thereby reducing their frequency. A risk assessment for a service user who is responsible for their own medication did not provide care staff with clear guidance as to how they should approach or deal with the identified risks (See Requirement 1). Point House DS0000027360.V351920.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): 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with choice and variety their lifestyle, and supported to maintain family relationships. Meals are sufficient to provide people with choice and variety. EVIDENCE: Some people prefer to remain at the home to take part in activities during the day. These service users play their part in the day to day running of the home, assisting in cooking or domestic tasks, or going shopping. Other service users that choose to access further education, attend voluntary work placements, or attend day centres in Norwich. People through discussion spoke of their attendance at various local and community facilities. Some service users evidently prefer to attend local facilities either on foot or using local transport, others spoke of enjoying trips provided by the home at weekends. The manager states that there are trips organised on a daily basis. Service users spoke enthusiastically about places they had been in their vehicle, a 6 seater ‘people carrier’. Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 12 Two people spoke about contact that they have with their family, saying that they could visit family members when they wish, or receive visitors when they wish also. Care staff were observed talking to and interacting with service users throughout the site visit, and they were supportive of people’s chosen routines. For a number of people this involved participation in ‘household’ jobs that would benefit the wider group. A choice of meals was available over the week, these are prepared by care staff and service users sometimes assist. Menus reflected a varied diet and staff stated that service users are involved in both setting the menus and in shopping for some provisions. The kitchen was safe, clean and tidy. Through discussion during the visit people living at the home were generally more than satisfied with the food. The home evidently uses a powdered milk formula made up by staff rather than milk already in its liquid form. The norm seems to be that service users are offered the made up powdered milk, though liquid semi-skimmed milk is purchased every day. Care staff stated that people at the home had not complained about this and that if preferred milk in cartons or similar could be provided. In general information about the service requested from the manager prior to the site visit, she included a wish to ‘improve food nutrition in line with government guidelines’ and stated that she would evaluate food nutrition with a view to improving the diet on offer. Point House DS0000027360.V351920.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): 18, 19 & 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive support in the way they require. Their personal and healthcare needs are well attended to, with the exception of some medication practices. EVIDENCE: Some service users require assistance with personal care and hygiene, other people require prompts and other indirect support from staff. The individual preferences of service users are demonstrated in their care plans. Personal care is provided in such a way as to ensure people’s privacy and dignity. Entries within a sample of individual service users care plans and daily notes demonstrated that people have access to health services and professionals. This included referrals to the G.P, and the Community Psychiatric Nurse for advice. Other entries included liaison with the dentist, chiropodist, optician and other specialist health services relevant to individual need. Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 14 Storage arrangements for medication are tidy and secure. The bulk of medication is available via the Monitored Dosage System (MDS), though there is also packet and bottled medication. Medication administration records (MAR) reviewed were well kept and carry useful information for care staff such as the medications purpose and particular precautions necessary in administration. An audit trail for sample medicines administered since the beginning of the current medication cycle identified no discrepancies. However, a fuller audit of medication against medication held from the previous cycle could not be undertaken because the home does not keep a record of all medication ‘carried forward’ (See Requirement 2). There are service users accommodated at the home who have responsibility for their own medication. Care staff keep good records of what medication is prescribed and what has been self administered. The risk assessments in place for service users who self medicate do not fully mitigate against identified risks. Such assessments should also indicate a reasonable timescale for reviewing arrangements (See Requirement 3). Point House DS0000027360.V351920.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): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for responding to the concerns and complaints of service users and staff are good. People who use the service are protected from abuse. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the service users guide. The manager and documents stated that no written complaints had been received since the last inspection of the home. Returned comment cards to the Commission for Social Care Inspection showed that people are aware of how to complain. Through discussion with staff it was evident that they are aware of their responsibilities if made aware of a complaint from either a service user at the home or other person associated with the home. Information supplied by the home as part of the pre-inspection paperwork required detailed that care staff have had training in recognising and understanding abuse. Staff confirmed that they are aware of the home’s policy and confident as to how they would raise any concerns they had immediately. The home has experience of making appropriate adult protection referrals through Norfolk’s joint agency ‘Safeguarding’ protocol. Point House DS0000027360.V351920.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): 24 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at the home is safe, suitably maintained and designed to support the needs of people who use the service and their carers. EVIDENCE: The premises are suitable for the homes stated purpose. The interior accommodation is in a reasonable state of repair, with adequate furnishings and fittings. There are large communal areas downstairs with television and other facilities including a small kitchen area for making tea, coffee or snacks. There is ongoing repair and re decoration of parts of the home necessary for a building of its size and use. Bedroom doors are all lockable to support privacy. The home is in a good state of repair externally. There is a paved patio which is used in the summer months for BBQ’s. There is new external signage to assist visitors to the home in finding it more easily, and the home has its own parking. The signage was changed by the manager following a concern that previous signage indicated the learning and behavioural needs of people who use the service. Premises were clean and hygienic throughout. Point House DS0000027360.V351920.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are trained, and deployed in sufficient numbers to support the specialist needs of people who use the service. EVIDENCE: There were 18 service users in residence at the time of the site visit cared for by four carers in addition to the manager - who stated this was the usual or approximate ratio. There is a care staff group of 14 including senior carers. Over 50 of the care staff group have an NVQ 2 qualification, with a further 2 staff currently undertaking this training the home should achieve over 70 of staff with the qualification. The manager is commended for achieving this. Information regarding staff training submitted by the manager show that staff have undertaken a range of mandatory training, including health and safety. Through discussions with staff and training records it was confirmed that they have undertaken a variety of courses, including specific training in areas such as autism to better understand the needs of the people living at the home. Observation of the interaction between care staff and people living at the home demonstrated good communication between them, and service users comments about staff at the time of the site visit were good. Staff observed appeared motivated and enthusiastic about their work. Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 18 Examination of staff files was undertaken to look at staff recruitment practices. It was noted that files contain proof of identity; verification of employment history, an application process including the taking up of references, and that Criminal Records Bureau clearance had been obtained. Point House DS0000027360.V351920.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home promotes the health and care of people who use the service, and has developed effective quality assurance systems. EVIDENCE: The registered manager has significant experience and is qualified having achieved the Registered Manager’s Award. Staff at the home commented that they have confidence in the manager and find her approachable. A service user commented that the manager had ‘done a great job here’ another service user said that the manager had ‘made it really nice here’. Quality assurance strategies include questionnaires for those associated with the home. The manager stated that she provides individual responses to those who make comment, and that results of quality surveys are published on the Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 20 home’s website. A comments book is available in the foyer of the home to any visitors. It is recommended that satisfaction surveys are extended to other ‘stakeholders’ such as community health and social care professionals (See Recommendation 1). Health and safety procedures such as fire safety assessments and checks have been carried out in liaison with qualified persons, and were noted to be satisfactory. Staff have received statutory health and safety related training, fire training support practices, food handling training and training in first aid. The fee range at the home is from £490 per week with additional charges for day care provision. Point House DS0000027360.V351920.R01.S.doc Version 5.2 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 3 2 2 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 12(1)(a) Requirement Timescale for action 27/09/07 2. YA20 13(2) 3. YA20 12(2) The Manager must ensure that the care plans and risk assessments indicate the care, treatment and supervision of people who use the service. This is to assist in ensuring the health and welfare of service users. The Manager must take steps to 31/10/07 ensure full and accurate records are completed at all times demonstrating medicines have been administered in line with prescribed instructions. This is to assist in ensuring the health and welfare of service users. The Manager must ensure that 27/09/07 risk assessments carried out to assess the safety of arrangements for any service users who look after their own medication, mitigate against identified risks. This is to assist in ensuring the health and welfare of service users. Point House DS0000027360.V351920.R01.S.doc Version 5.2 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 YA39 Good Practice Recommendations It is recommended that satisfaction surveys are extended to other ‘stakeholders’ such as community health and social care professionals Point House DS0000027360.V351920.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Point House DS0000027360.V351920.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. 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