Inspection on 13/07/05 for Priors Piece

This inspection was carried out on 13th July 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 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

Priors Piece 28/02/07

Priors Piece 11/01/06

Priors Piece 25/11/04

Priors Piece 18/05/04

Priors Piece 02/03/04

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

CARE HOME ADULTS 18-65 Priors Piece Priory Drive Totnes Devon TQ9 5HU Lead Inspector Graham Thomas Announced 13 & 14 July 2005 th th 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 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 Stationary 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. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Priors Piece Address Priory Drive, Totnes, Devon, TQ9 5HU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 863983 The Community Of St Anthony and St Elias The Very Rev Archpriest Benedict Ramsden, Mr Simeon Ramsden, Mrs Lilah Ramsden Mr. Dan McGill Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 25 November 2004 Brief Description of the Service: Priors Piece is a small, single storey residential home on the outskirts of Totnes providing care for up to three service users with mental health problems. The home is part of the Community of St. Anthony and St. Elias which has a number of homes in the Plymouth and South Hams areas. For ease of reference this will be referred to as “the Community” throughout the report. Each service user has a single bedroom and access to a kitchen and lounge / dining room. There is a small garden which includes a covered designated smoking area. Parking is limited as canoes and vehicles belonging to the Community are stored at the site. The Community provides a well-established outdoor activities programme for service users. Arts activities are also organised through the Communitys own arts co-ordinator. Other local opportunities for the maintenance and development of life skills in the home and local community are provided. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the course of this inspection, the inspector spoke with three service users, three staff members, the Registered Manager and the Community’s Health and Safety Officer. Feedback cards from relatives were reviewed as well as a pre-inspection questionnaire completed by the Registered Manager. The inspector toured the building and joined staff and service users for lunch. All the service users’ plans were examined as well as staff records and other documents. What the service does well: What has improved since the last inspection? What they could do better: The bathroom needs redecorating and new flooring is needed in the lounge / diner. The informal arrangements for key work with one service user could be extended to all service users to focus more closely upon their individual needs. Staff need to be trained to a level which meets national standards. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 6 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. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 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 standard(s) 2 Service users have the information they need make an informed choice about living at Priors Piece. EVIDENCE: At the time of inspection, there had been no recent admissions to Priors Piece. Discussion with the Registered Manager confirmed recorded evidence of a thorough pre-admission assessment. This includes meeting a prospective service user in their current placement, gathering information from referring authorities and pre-admission visits to the home. Goal-focussed care plans are formulated and files contained details of the Care Programme Approach and information gathered from other professional sources. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Service users are well supported to understand their individual plan and make decisions about their lives. A thorough system of risk assessment and planning supports service users in taking responsible risks EVIDENCE: A very well-organised care plan file is kept for each service user. The care plans were clear and goal-focussed identifying specific areas of personal and healthcare support. The plans showed evidence of regular review and had been signed by service users. Where service users had not signed the plan, a note had been made as to the reason. Details of restrictions on personal freedoms and choices were identified in the plans. Some of these had been legally imposed and others were part of agreed risk management strategies. Strategies for identifying potential challenging behaviour and managing incidents were clearly set out in the plans and risk management documents. Service users at Priors Piece require a high level of support. However, individual plans identified areas in which service users’ autonomy could be promoted and staff were observed offering day-to-day choices such as those concerning meals and activities. Individual risk assessments were up to date and had been recently reviewed. Each was allied to a management plan which provided staff with clear guidance Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 10 as to the level of risk and how to manage / minimise the risk. Staff had all signed a form to indicate that they had read all service users’ plans and risk assessments. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17 Service users are well supported to maximise choices about their lifestyle and activities. EVIDENCE: At the time of inspection, no service users were in open employment though all have been offered the experience of voluntary conservation work. One service user is supported to maintaining his interest in playing classical guitar. His other major interest in cricket was recently pursued by attending a County cricket match with staff support. The contents of service users’ rooms reflect their individual interests and activities. The Community has an extensive outdoor activities programme to which all service users have access. Arts activities are also supported through the Community’s own arts co-ordinator. On the day of inspection, two service users attended a sports centre. Service users participate in community life by visiting pubs, cafes, sports facilities. Shared transport is available if required. The shift pattern adopted by the Community means that there are few restrictions on the timing of activities. Holidays are included in the contract price are available to service users. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 12 Staff and the Registered Manager showed respect for service users’ individual space by knocking on doors before entering. Preferred forms of address were in use during the inspection. Service users were making clear choices about their participation in activities and whether they wished to be in company. Staff were interacting well with service users. Service users were participating in the home’s daily routines according to their individual needs abilities. Rules on alcohol, smoking and drugs are clearly stated in the home’s documentation. Discussion with service users and individual plans showed how contact with family and friends was supported. Meals are planned on a shift by shift basis in consultation with service users. A new recording system has been introduced which provides more detailed monitoring of menus and meals taken. The Inspector joined staff and service users for lunch. This was taken in a relaxed and congenial atmosphere. Meals include fresh ingredients and fresh fruit was seen to be available. Dietary monitoring is conducted on the basis of individual need. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, and 20 Staff provide service users with a level of personal support which meets their individual needs EVIDENCE: Individual plans identified specific areas of personal and healthcare support required for individuals. One individual spoke of the recent death of a close relative and the support given by staff to attend the funeral and come to terms with the loss. Flexibility in the daily routines of the home was seen in action during the inspection. Care plans identified guidance and support required by individuals regarding matters of personal hygiene. The plans also showed the involvement of a range of professionals in relation to general and specialist healthcare support. During the inspection one service user attended the GPs surgery for routine treatment. An informal key working arrangement exists for one service user and this should be extended for all service users. Systems for the management of medicines in the home were inspected. A monitored dosage system is in operation and records relating to this were found to be in order. There were no controlled drugs in use in the home at the time of inspection. Patient information leaflets are held for all the drugs in use and there is a medicines information file for staff reference. An approved list of homely remedies was seen during the inspection. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 14 Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Service users are able to feel that staff listen to their concerns. Service users can be confident that hey will be protected from abuse because staff receive appropriate training. EVIDENCE: Clear policies and procedures are in place concerning, complaints, protecting vulnerable adults from abuse and whistle-blowing. Service users have copies of the complaints procedure. Records showed that no complaints had been received by the home and none has been received by the Commission. Staff are subject to CRB / POVA checks as part of the recruitment process. All staff receive training in the protection of vulnerable adults from abuse as part of their induction. Training is also given to staff on diffusing and managing aggression. Confirmation has been received by the Commission that current banking arrangements for service users safeguard their monies. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 Priors Piece provides a generally comfortable, clean and safe environment for service users. EVIDENCE: The home’s premises provide a safe and comfortable living environment for service users and are close to local amenities. Communal space includes a lounge – dining area and gardens to the rear of the property. On inspection the home was clean and free from offensive odours. Furnishings and décor are of a domestic type. Despite improvements in the lighting, the lounge area remains short of natural light. However, due to the building design there are few further improvements which could be made. Since this standard was last inspected, carpets in the hall and office have been replaced. The carpet in the lounge/dining area is now showing signs of age and wear. Redecoration is required in the bathroom There is a comprehensive set of health and safety policies in place and the home has a current fire risk assessment. The home has a separate utility area which houses the washing machine and a new tumble dryer. The laundry area has an impermeable floor and cleanable walls. Confirmation has been received by the Commission that the washing machine meets the Water Supply (Water Fittings) regulations 1999. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 17 There are policies in place for the control of infection and materials, systems and equipment in place such as infected waste disposal bins. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Service users receive support from a staff group which has good basic training. However, training to meet national standards is insufficient. EVIDENCE: Planning for staff training is conducted centrally within the Community. Discussion with the newest member of staff confirmed that he had received intensive induction training for two weeks prior to working within the Community’s homes. This was followed by a period of further foundation training which was recorded in an individual file held by the staff member. The induction training includes elements concerning understanding mental health needs and other topics relevant to service users’ needs. Discussion with staff and individual files also confirmed that staff have access to training in health and safety topics including, for example first aid updates. The Registered Manager indicated that, apart from himself, there are currently no staff qualified to NVQ level 2 or above. The home will therefore not meet the national training target by the end of 2005. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 Service users have yet to contribute fully to an improved quality assurance system. The health and safety of service users is generally well safeguarded. EVIDENCE: A new quality assurance system was being introduced at the time of inspection. This is based on the use of information gathered during Providers’ visits and other data which feeds into regular quality assurance meetings. Consultation with service users takes place during the Providers’ visits though further formalised systems are envisaged, including a service user survey. Some recording systems in the home such as menu monitoring and activity records have been improved as a consequence of quality reviews. Health and safety records showed up to date checks in respect of: Fridge and freezer temperatures; fire equipment and alarms; fire drills; gas safety; electrical wiring and personal appliances; water temperature. Staff are trained in health and safety subjects including food hygiene, moving and handling and first aid. Hazardous substances are securely stored and data sheets are kept in the home. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 20 Policies and procedures for safe working practices and environmental risk assessments were available for inspection. The environmental risk assessments are now due for review and updating. Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 4 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Priors Piece Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 22 no 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 35 Regulation 18 Requirement The Registered Manager must produce a plan as to how national staff training targets in respect of NVQ training will be met and supply a copy to the Commission Timescale for action 31 October 2005 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. 3. Refer to Standard 18 24 24 Good Practice Recommendations The informal arrangement of key working for one service user should be formalised and extended to all service users The bathroom should be redecorated Consideration should be given to renewing the floor covering in the lounge / dining area Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Priors Piece D54-D07 S3781 Priors Piece V224101 130705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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