Inspection on 12/10/05 for Powys House

This inspection was carried out on 12th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Powys House 11/09/06

Powys House 27/04/05

Powys House 05/11/04

Powys House 11/05/04

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

CARE HOME ADULTS 18-65 Powys House Powys House 121 York Avenue East Cowes Isle of Wight PO32 6BB Lead Inspector Mark Sims Unannounced Inspection 12th October 2005 13:00 Powys House DS0000055743.V249203.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 Powys House DS0000055743.V249203.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. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Powys House Address Powys House 121 York Avenue East Cowes Isle of Wight PO32 6BB 01983 291983 01983 291983 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) Harrison Care Enterprises Ltd Mr Richard David Harrison Care Home 18 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (3), Mental disorder, excluding of places learning disability or dementia (4), Old age, not falling within any other category (2), Physical disability over 65 years of age (1) Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27 April 2005 Brief Description of the Service: Powys House is a large period building which has been converted to provide residential care to a mixed client group, offering services to younger and older adults with learning disabilities, older persons, 2 places under the category of mental disorder and 1 category for someone with a physical disability. The premises is situated about midway along York Avenue, East Cowes, which is the main thoroughfare into the town and provides service users with easy access to the facilities and amenities of the East Cowes, including sources of transport. The building, as highlighted, is a period town house, which has been extended and adapted to provide residential accommodation, including a passenger lift servicing all floors, portable ramped access to the home, assisted bathrooms, etc. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection formed the second statutory visit of the year for Powys House and was again conducted on an unannounced basis, focusing on those core inspection standards not reviewed at the last visit. In total the inspection lasted four and a half hours, the inspector during that time meeting with service users, reading through documentation, touring the premises and observing staff practice and interactions. What the service does well: What has improved since the last inspection? What they could do better: Whilst little had improved during inspection visit some areas of the home or its practices had deteriorated including: Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 6 Many internal aspects of the home are in need of attention, specifically a number of service users’ bedrooms require redecorating and corridors, etc. updating. A large number of fire doors around the property were found being held open by means that would not ensure closure of the door in the event of fire. Assessments of prospective new service users were being carried out, although there was no structured process for documenting the assessments and no indication of how this would link into the care planning process. The service users’ medication, managed by the home, should have been stored individually according to the person it is prescribed for, however a far more ad hoc approach was being used by the home, leading to medicines being haphazardly stored. 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. Powys House DS0000055743.V249203.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 Powys House DS0000055743.V249203.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): Standard 2 The home’s approach to the management of pre-admission assessments is confusing, as some good practice is offset by some poor record keeping. EVIDENCE: The admission process experienced by two recently admitted service users was explored with the deputy manager. What was clear from the conversation, and records produced, was that the home and in particular the management team has introduced some very good and positive pre-admission practices, including: 1. Multiple visits to the individuals subject of the proposed move. 2. Several supported visits to Powys House undertaken by the individuals prior to accepting the offer of accommodation. 3. Maintenance of contact with care managers working with the service users subject of the move throughout the process. However, whilst these areas of the home’s approach to the pre-admission assessment process were good, the record keeping, which operates alongside such practical exercises, was less convincing: 1. With no specific pre-admission assessment tool available for either the manager or his deputy. 2. Little meaningful information gathered or obtained via the care managers Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 9 3. Little discharge information gathered or provided by the previous care service. It is imperative if good levels of care are to be provided, or a consistent service offered, that as much useful information is gathered prior to the person’s arrival as possible and that this information is used to generate meaningful initial care plans that can evolve and grow as the person settles and relaxes into their new environment. Fortunately from the perspective of the service users the whole pre-admission process and the move to a new home went well, with both parties clearly enjoying life at Powys House and clearly both settling well. In conversation with both parties it was apparent that the opportunity to meet the manager and the deputy manager prior to visiting the home had been useful and that the two planned visits had helped them decide to accept the offer of accommodation. However, whilst these admissions have gone well, this cannot always be guaranteed, especially where information gathered might indicate or suggest potential problems, which could and should be addressed via the assessment and care planning systems. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 10 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): Standard 8 The service users are very clear about the choices offered to them as part of their lives at Powys, and feel included in the decision-making process. EVIDENCE: It became very clear, very quickly, that the service users feel able to participate in all aspects of life within the home and that they consider themselves central to the decision-making process, especially where they, in particular, are concerned. A good example of this came when discussing holidays with the service users, each person clearly having enjoyed the experience and all recounting different aspects of the holiday that they had found funny or enjoyable. In order to make the holiday manageable from the perspective of the staff and management it was decided that two dates would be scheduled for the holiday and that half the client group would visit Bognor Regis in September and the second half in October. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 11 The decision on who would go on which date was largely determined by the management, although from conversations with the service users it was apparent that they had been consulted and felt their input valued. The two groups decided upon largely reflected the numbers of available staff and the dependency levels of the service users wishing to go on the dates available. What was clear from talking to the service users was that they had not felt pressured into going on the holiday, several people opting to remain at home in preference of visiting Bognor Regis, and that they had appreciated the option of having a trip away. Whilst on holiday the service user groups appear to have been given a relatively free rein to entertain themselves, choosing what activities they attended and/or participated in, although often the activities were group orientated. On the whole the holiday would appear to have been a great success, which was enjoyed by everyone who attended, staff included, and which has generated a lot of conversation and merriment within the home. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 12 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): Standards 15 & 16 Service users are appropriately supported when establishing and maintaining personal relationships. People’s rights to self-determination and freedom of choice are clearly promoted by the ethos of home. EVIDENCE: Family links are both encouraged and supported by staff and many of the service users are in regular contact with family and friends, many of them local to the Island. Within the home clear friendships have been formed although all parties residing at Powys House appear to get on and by and large enjoy social occasions and social interactions. As many of the service users attend the same day centres or work placements they often share friends and/or acquaintances, which helps further in the fostering and developing of friendships. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 13 The general ethos and philosophy of the home would appear to be to encourage and promote independence, and this was evident when talking to some of the service users. Residents are encouraged to keep their own bedrooms clean and tidy, although on occasions the support of staff might be needed. Wherever possible service users are supported in developing daily living skills, one person in particular was noticed to be involved in preparing her packed lunch for the next day and others discussing cooking they were involved with at their day centre. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 14 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): Standards 18 & 20 Personal support is provided to service users in accordance with their specified wishes. Aspects of the home management of service users’ medication are inappropriate and cannot therefore ensure the safety and wellbeing of service users. EVIDENCE: The abilities of the service users to meet their personal care needs are varied, with some people more readily able to manage this than others who might require assistance from staff. Throughout the inspection process the inspector encountered no individual who appeared unkempt, most people appearing to be well supported with their personal care needs. It was established through observations that some people require prompting with regards to accessing the toilets and washing hands, etc. afterwards, although the staff sensitively handled these occasions. In conversation with the staff and deputy manager it was established that a keyworker system is in operation within the home and that on average staff Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 15 support two to three service users, the role entailing general support, assistance with purchasing clothing, toiletries, etc. The care planning process, although a little rigid for the home, does provide staff with the scope and facility for documenting when and how people prefer to have their personal care needs met. The review of the home’s medication system was a bit of a mixed experience with most of the system operating reasonably: • • • • • Medications being ordered via a repeat prescription system. Medication booked in on the Medication Administration Sheets (MAR). Medications signed for on administration. Returns appropriately handled. Sample signature for staff that have completed the Boots training programme available. However, the storage of the service users’ medications was very ad hoc and confusing, whereby normally medications should be stored under the name of the individual to whom they are prescribed, the home’s medicines were littered across the medication trolley. Whilst clearly this was not causing any immediate problems for the staff it is not considered good practice and cannot be considered appropriate from the perspective of service user safety. The deputy manager has been asked to address this issue, although a planned review by the community pharmacy team should help. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 16 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): Standard 23 The practice and polices of the home are designed to safeguard and protect service users from abuse. EVIDENCE: A copy of the Isle of Wight Social Services Adult Protection Policy and Procedure is available together with a copy of a policy operated under the previous proprietors. Staff generally receive training around adult protection issues via induction training, the Learning Disabilities Award Framework (LDAF), which is now in operation within the home, although on a limited basis and National Vocational Qualifications (NVQs), which are also now being introduced into the home’s training schedule. Staff observed during the inspection demonstrated on several occasions that they have an awareness of adult protection issues and their responsibilities when interacting with the clients. Staff are clearly aware of their relationships with service users and careful not to cross established physical boundaries between themselves and the service users, i.e. no over-familiar touching or hugging of people, careful use of language and terms of address, etc. The management also demonstrated through one particular act their willingness and ability to use and implement the adult protection procedure, reporting a potential financial abuse to the local authority for investigation, the abuse involving outside agents/parties and not staff or service users. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 17 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): Standards 25 & 28 Some service users’ rooms are in need of redecoration. Some shared or communal areas of the home, including corridors, require redecoration. EVIDENCE: A partial tour of the premises was undertaken with the deputy manager, partially indicating that not every bedroom was visited during the inspection, although each floor and all communal facilities were inspected. Several areas of the home during the tour were found, decoratively, to be below a reasonable standard of presentation, these areas were brought to the deputy manager’s attention at the time of the tour. It was also noticeable that several corridors, etc. were also in need of some remedial work, as again the decorative condition of those areas was falling below an acceptable standard, although generally the home was clean and tidy. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 18 In conversation with the service users it was clear that they were generally very happy with the overall condition of the home, which apart from the areas brought to the deputy manager’s attention, was alright and liveable. Communal facilities are large and spacious and offer people the opportunity to socialise within different settings, the lounge/diner appearing to be the main social hub of the home and the second lounge acting as a quieter retreat should people wish. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 19 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): Standard 35. Staff training and development opportunities are improving. EVIDENCE: At previous inspection visits the staff have always shown a reluctance towards embracing training and development opportunities, largely influenced by the previous proprietor’s attitude towards training opportunities and a slightly older staff team, who considered themselves too long out of education to achieve educational goals. However, with the intervention and employment of the deputy manager this previous reluctance appears to be subsiding, with several staff now tackling National Vocational Qualifications and/or Learning Disabilities Award Framework courses. In addition to these more intensive or time consuming courses, staff are also beginning to tackle short courses such as the Boots medication training course, mentioned earlier, and core or mandatory training i.e. food hygiene, moving and handling etc. In conversation with the deputy manager it was also established that she is currently completing her National Vocational Qualification at level 4 and Registered Manager’s Award, which should in time lead to her becoming the overall manager of the service. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 39 and 42 The service users were very happy that their views and opinions are listened to by the staff and management. The practice of holding fire doors open with devices that will not release on the sounding of the fire alarm is unsafe and place people at undue risk. EVIDENCE: Each service user has a named key-worker who gets to know the service user well and is able to involve them, as appropriate, in decisions about the home and service provided. Service users are included in their care reviews as far as is possible, although considerations around cognitive limitations or physical barriers, etc. have to be given at times. In discussion with the service users it was very clear that they appreciated who their keyworker was and felt that the person involved them in key decisions about them and the home in general. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 21 It was also apparent that the manager spends a lot of time with the service users, which they and the staff appreciate and that he uses his time with people to monitor and gauge their satisfaction with the service, as well as listening to suggestions for change or developments they may wish to try. The tour of the premises brought into focus the practice of holding fire doors open with devices which will not release should the fire alarm sound. Whilst it is acknowledged that at certain times of the day individual doors might be held open by such means, these objects should be removed once staff have completed their task, etc. It is imperative given the high risk of fire and smoke spreading through the home, should a blaze break out, that the manager make contact with the local fire officer and discuss suitable and practical measures to address the issue in the best interests of all parties. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score X 2 X X 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Powys House Score 3 X 2 x Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 x DS0000055743.V249203.R01.S.doc Version 5.0 Page 23 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 YA20 Regulation Requirement Timescale for action 09/01/05 2 YA25 3 YA42 Regulation All service users medications 13 must be held on an individual basis, according to the person named. Regulation Attention is required to the 23 decorative condition of several service users’ bedrooms and corridors leading to service users’ bedrooms, a schedule for addressing these issues must be provided to the Commission. Regulation The registered person must 23 consult with the local fire authority regarding the practice of holding fire doors open. 09/01/06 09/12/05 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 YA2 Good Practice Recommendations A specific assessment tool should be created, which feeds into the service user’s plan. Powys House DS0000055743.V249203.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. 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