Inspection on 24/01/06 for Prospect House Residential Home

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Prospect House Residential Home 31/07/07

Prospect House Residential Home 23/08/06

Prospect House Residential Home 02/08/05

Prospect House Residential Home 16/03/05

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 Prospect House Residential Home 4 Prospect Road Cinderford Gloucestershire GL14 2DY Lead Inspector Mr Simon Massey Unannounced Inspection 24th January 2006 9:30 Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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 Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Prospect House Residential Home Address 4 Prospect Road Cinderford Gloucestershire GL14 2DY 01594 826246 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Silver Rooms (Stroud) Ltd Mr Graham Clive Emery Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9) of places Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Prospect House is a detached residential care home set in its own grounds near the centre of the town of Cinderford. It is registered for nine adults with Learning Disabilities. All of the bedrooms are single and some have en-suite facilities. On the ground floor there is a lounge, dining room, kitchen, toilet, shower room with a toilet and three bedrooms, one of which has its own entrance. On the first floor there are six bedrooms, a bathroom, toilet, laundry room, storeroom and sleep-in room/office. There are spacious grounds surrounding the house. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by Simon Massey and Tanya Harding over 5 hours on 24th January 2006. The inspectors examined records relating to staff records , care plans, medication administration, health and safety and staff training. The inspectors met with the Registered manager, the Registered Provider, three care staff and all of the service users. An inspection of the environment was also carried out. The home was purchased by the present provider 12 months ago and work has continued over this period to address the large number issues that where inherited. What the service does well: What has improved since the last inspection? The home has continued to complete new assessments on the service users in conjunction with outside professionals. The new care plans that have been completed represent a significant improvement on those previously in place. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 6 A new kitchen has been fitted and the laundry room moved to a more suitable location. Various other improvements have been made to the environment, including new furniture, new doors, redecoration and a new hydro bath. There has been an increase in the number of activities and outings undertaken or supported. 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. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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 Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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): 1,2 & 4 The new Statement of Purpose provides accurate information about the home. Implementation the home’s admission policy should ensure that the needs of prospective service users can be thoroughly assessed before they are offered a placement. EVIDENCE: The home has produced a new Statement of Purpose, which was shown to the inspectors. This document contains all the information that is required under the regulations and provides a good picture of what care and support the home provides. The home is taking referrals to fill the vacancy and the manager confirmed that the home was following it’s admissions policy. Information and assessments gathered on potential service users should help ensure that the needs can be met of anyone coming to live at the home. Service users will have the opportunity to visit and stay at the home before making a decision about moving in. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 New care planning system, once completed, should provide staff with better guidance on supporting the needs of service users. Regular consultation with service users should ensure that they are more involved in making decisions about their lives. EVIDENCE: The home has started a process of rewriting the care plans and introducing a new format for identifying and reviewing goals and objectives. A sample of the completed files were seen. The plans contain personal details, a pen picture of the basic support that is required and information about weekly routines. There is also information about social activities and a record of health appointments. The plans contained information about daily living needs and the support required to complete shopping, cleaning and managing money. A recommendation is made that more detail could be provided in respect of the plans to support better understanding and management of money. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 10 One file contained a behaviour management plan that had been written and then reviewed after 6 months. The plans seen had been signed by the manager, key-worker and the service user. The manager stated that the new plans would be completed for all the service users by April 2006. All the files showed that there had been an increase the amount of recording being completed, and also that more detail was now being included. The manager confirmed to the inspectors that the home, in conjunction with other professionals had made the decision that the home could no longer meet the needs of one service user. This is due to increased needs resulting from the onset of dementia and increased behaviour difficulties that are impacting upon the care of the other service users. A new placement is being sought. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Improvements have been made to the quality of life of the service users, and progress is continuing in this area. EVIDENCE: On care plan seen contained information about supporting family relationships and all files contained details of family contacts. All service users have an activity timetable in place that details their activities for the week. These show that there has been an increase in the amount and variety of activities undertaken, both during the day and also in the evenings and weekends. These include college courses, woodworking sessions, IT courses, Art Sessions, Dance and Movement and sports. Saturday is generally allocated as a shopping day. The timetables are also provided in a picture format. The home provided a week’s holiday in Devon for all the service users in the summer of 2005. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 12 Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Progress is continuing in identifying and meeting health and personal needs of the service users. Systems for administration and storage of medication are satisfactory. EVIDENCE: The care plans provide detail about the personal care that is required and contain guidance for staff. One plan stated that the service user required assistance with getting into the bath but did not provide more detail. It is recommended that these plans should provide more precise instructions as to what support is required. Plans also contain guidance for staff on how to best promote privacy and dignity when supporting personal care tasks. The files contained details of health appointments to Doctors, Dentists and also with professionals from the Community Learning Disabilities Team. The manager is starting to develop Health Action Plans and there was evidence of support from the local GP in completing these. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 14 One care plan seen contained information relating concerns a service user may have over their health and also contains a record of their wishes for their funeral arrangements. The weight of the service users in monitored and recorded and one file contained a record of the concerns relating to the person and their weight loss. The subsequent input from the GP is also recorded. The home have organised and supported input from the Community Learning Disabilities Team to complete updated assessments on several service users. The manager stated that the staff and service users were really benefiting from this input. Under the previous ownership of the home there were some difficulties in service users accessing the appropriate input from outside professionals. This led to an urgent need under the new manager for assessments to be updated to ensure that the physical and emotional health needs of the service users were being identified and met. On the day previous to the inspection the home had been visited by the consultant psychiatrist who provided advice on behaviour management and medication for two of the service users. The medication and storage systems were examined and found to be in order. The bottom drawer of the medication cabinet was a little cluttered and there was also a sizable collection of homely remedies, not all of which were labelled as to when they were opened or first used. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 There are systems in place for protecting service users and responding to complaints, although these need to be improved in certain areas. EVIDENCE: The home has recorded “incident reports” on situations and behaviours that have occurred. Some of the recording demonstrated inappropriate responses from staff towards service users who may have behaved in a challenging manner. Service users had been “told off” and one person had had certain personal items removed as a punishment. The manager explained that this practice had been addressed and has been stopped. Clearer guidance to staff had resulted in decreased behaviours requiring intervention. There had now been no recorded incidents since July 2005 for one person and October 2005 for the other. The home has a complaints recording book and this showed that a complaint had been made by the service users about a staff member and their conduct towards the service users whilst on holiday. This ultimately resulted in the staff member being dismissed. However this incident was not reported as it should have been to the Commission and a requirement is made in relation to this. The home must supply the details of the complaint and subsequent action. Information must also be supplied confirming what consideration was given to making a referral to POVA register. The manager stated that he had organised some training for staff on the issues of POVA and prevention of abuse. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 27, 28 and 30 A process of gradually updating and improving the environment of the home has been continuing for several months. This has made the environment feel more homely and personalised. EVIDENCE: In the living/dining room, the old fireplace has been removed and some wood panelling has been fitted. The French windows have been replaced, and with the new furniture this has become a comfortable and homely area for the service users. The old dining room is now a living room with new settees and also a new television. This is a comfortable and spacious area. The fireplace has not been removed and is still boarded up, but there are plans to panel this space and also decorate the room when this is finished. A new kitchen and new appliances have been fitted and decoration is due to be completed in this area. The laundry room has been moved to its original location upstairs and the old laundry off the kitchen is now a storage area for the kitchen as well as providing access to one of the bedrooms. This has greatly improved the Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 17 environment and made infection control measures easier to maintain and monitor. All the bedrooms were seen and improvements have been made in all of these. Some rooms have new carpets and furniture and most have had a degree of redecoration. The upstairs bathroom has had a hydro bath fitted and a new blind and, when decorated, will be a significant improvement on the previous facilities. As detailed in the previous two reports the new Provider inherited a large volume of environmental improvements that needed to be made and evidence was seen that this is progressing. The manager and provider explained some of the difficulties in the sequencing of work and also the difficulties posed by the continued challenging behaviours of one service user, whose needs the home can no longer meet. The home has installed steps and some handrails to provide safer and easier access to the new hydrotherapy bath that has been installed. A new step has also been provided to ensure safe entering and exiting of the home’s mini bus. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Improved staffing levels mean that needs of service users can be better met. Recruitment procedures need to be improved to offer better protection to service users. The effectiveness of the new staff could be increased through improved structured supervision. EVIDENCE: The staff files were examined and found to be largely in order with the required information in place. All files contained employment histories but one file contained a series of dates that appeared to overlap and require explaining. One file contains information about a staff member being dismissed from a former post. The manager stated they had followed this up and received a satisfactory explanation but this was not recorded and should have been. One file contained details of a disciplinary that the home had organised. This was correctly recorded and the manager explained the circumstances and the action he had taken. However the Commission was not notified of this incident, as they should have been, and a requirement is made in relation to this. The Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 19 manager must ensure that he and the staff team are aware of the requirement and scope of regulation 37 relating to notifiable incidents in the home. The reference forms that the home sends out provide insufficient evidence or information about the source of the reference. The home needs to ensure that the referee, and the name of the firm or employer, is clearly named on the form. The forms should provide reasonable evidence that it is a genuine reference. Records show that formal recorded staff supervision has been irregular and this needs to be addressed by the manager. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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): 37 and 42 Service users have benefited from greater stability and direction from the manager. Greater focus on assessed needs and strategies and plans to meet these have improved the quality of the service. Efforts have been made to improve the safety of the home although some gaps still exist in fire safety monitoring. EVIDENCE: These standards were not examined in detail during this visit but the home is being provided with direction by the manager and provider. The manager is able to demonstrate an understanding of the priorities that must be dealt with and it is evident that an improvement in the quality of life for the service users has been achieved. As the new care planning system becomes more familiar to the service users and staff team, it should help ensure that a solid base is in place to respond to assessed needs and make further plans for the future. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 21 The manager has been addressing a variety of issues since being registered and this inspection showed that progress is continuing. The home has had to deal with changes in staff and changes to the care practices. Also the various reassessments of the service users have produced new challenges that needed considering. The manager has overseen the changes that have resulted in better day care activities for the service users, increased social opportunities, and a greatly improved physical environment. A sample of questionnaires returned by parents and families were seen and these provided positive comments about the care provided. An examination of the fire safety procedures showed that weekly tests had not been completed since the beginning of December 2005 and a requirement is made in respect of this. All equipment had been tested at appropriate intervals and another service was due to take place in early February 2006. Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 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 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x X 3 X X X X 2 x Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 24 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 14 and 15 Requirement Timescale for action 31/03/06 Complete reassessments of needs for all service users and ensure these are reflected in care plans (previous timescale (30/11/05) 3. YA6 15 Ensure care plans 31/03/06 comprehensively cover all areas of support for service users (previous timescale 31/01/06) 5. YA24 23 Address outstanding 31/03/06 requirements to improve aspects of the environment and facilities in the home, as detailed in the text. previous timescale31/01/06) 6 YA34 22(8) The home must supply details of 31/03/06 the complaint made against a staff member and the subsequent action taken by the home as identified in the report 7 YA23 37 The home must ensure that all 31/03/06 staff are aware of the legal requirement to notify the Commission of incidents within the home 8 YA23 19(1)(a&b) The home must ensure that 31/03/06 employment histories for new staff are thoroughly examined and seen as accurate 9 YA23 19(5)(d) Information collected during the 31/03/06 recruitment process relating to information on application forms must be recorded 10 YA36 18(2) The home must ensure that staff 31/03/06 receive regular recorded supervision 11 YA42 23(4) The home must ensure that all 31/03/06 fire tests are carried out andVersion 5.1 Prospect House Residential Home DS0000061957.V280213.R01.S.doc Page 25 correctly recorded 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 YA6 YA23 Good Practice Recommendations Care plans should contain more detail about the support needed for service user’s to manage and understand their finances The home should amend the staff reference request forms as explained in the report Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Prospect House Residential Home DS0000061957.V280213.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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