CARE HOME ADULTS 18-65
Rachel Mazzier House 25 Chatsworth Road Brighton East Sussex BN1 5DB Lead Inspector
Jenny Blackwell Unannounced 31 August 2005 11.30 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. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Rachel Mazzier House Address 25 Chatsworth Road Brighton East Sussex BN1 5DB 01273 564021 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) Sussex Tikvah Ms Joanne Osbaldston Care Home (PC) 6 Category(ies) of Learning Disability (LD) 6 registration, with number of places Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The number of service users accommodated must not exceed six (6) 2 The service users accommodated will be between the age of eighteen (18) and sixty-five (65) years on admission Date of last inspection 4 March 2005 Brief Description of the Service: Rachel Mazzier is a registered care home providing support for 6 people of the Jewish faith who have a learning disability.The Jewish Charity, Sussex Tikvah, runs the home. The committee includes parents, social workers, services users and other members of the community.Brighton Housing Trust owns the building. Under this arrangement, the Trust is responsible for all external maintenance. It is the responsibility of the charity to provide for the overall care of the 6 service users, internal maintenance and the up keep of the internal fixtures and fittings.The home does not have level access and parking is restricted due to pay and display bays. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During this summary and report the people who live at the home will be referred to as people/person (except in the requirements section where the collective term of service users is used), and the people who work at the home as staff or by their job title. People who live at the home, some of the staff team and deputy manager were present during the inspection. Time was spent with two of the people who live at the home. The manager was not present during the unannounced inspection and two staff were spoken to throughout the visit. The requirements made from the inspection in March 2005 were check to see if they had been met. The deputy manager produced evidence to show that all of the requirements and recommendation had been met. The people who live at the home and the staff were helpful throughout the inspection and contributed to the report where possible. What the service does well:
The home is set up and run to enable the people who live there as much independence from the staff as possible. Each person is able and expected to contribute to the daily running of the home. The people meet regularly to work out who would be doing what task throughout the week and discuss any issues. One person was spoken to about her experiences of living at the home. She stated that she was very happy with the support she received from the staff. She said the staff would help her to sort out some things that may otherwise caused her some anxiety if she was doing it alone. The people who live at the home maintain a level of independence from the staff and go on holidays, visit families and friends alone. The staff appeared to offer a good level of support when needed and were sensitive to when people wished to take measured risks when acting independently. The staff on duty were seen to act professionally and respectfully with the people. Both the people spoken to said they were happy at the home and felt they got on well with the staff. They said they would be confident to go to their keyworker or the manager if they were not happy with anything. The staff spoken to were able to demonstrate knowledge of each person support needs to practice their faith. The staff had been supported by the organisation to attend training and awareness days about the Jewish faith.
Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 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 Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 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) 1 and 2. The manager and staff had access to policies and documents that help them to support new people move to the home. The Statement of Purpose for the home was appropriate for the current group of people. The individuals needs and aspirations were assessed. EVIDENCE: The statement of purpose and service users guide was appropriate for the current group of people at the home. The deputy discussed that the document is kept under review and would be changed if the needs of the people changed. Whilst looking at the care plan it was noted Brighton and Hove City Council, the people’s placing authority, had reviewed their placements and were up to date. The home also ensures that they undertake six monthly reviews with each person and their families and friends. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 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. The person’s individual care plans contained information based on people’s preferences, their likes and dislikes and health care needs. Each plan was well written and was presented in the same format. Each person is engage by the staff to make decisions about their lives and are supported to take measured risks. EVIDENCE: The care plans contained good information about the current support needs and the wishes of each person. The person had signed some sections such as the short-term goals. This evidenced that the staff where aware that the individuals where at the centre of their support planning. The staff ensured that people where in a position to make decisions about their lives. During the discussion with the people at the home both talked about making decisions in their lives. One person talked about the holiday plans she had and what holidays the other people had been on. At each stage she was supported to make choices about where she wanted to go and whom she wanted to go with. The other person talked about the meetings the people have at the house to decide what would be happening during the week. Decisions where taken about who will prepare the meals and do the household shopping.
Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 10 It was apparent from the discussions that the people views are regarded highly by the staff and that the people felt able to voice their views in a safe environment. The staff support the individuals to take measured risks in all aspects of their lives. This included self medicating and travelling alone. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 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) 11-17. The staff were committed in supporting each person with their interest. Personalised activity information was in place for each individual. Each person was actively engaged in their local community and have good links with family and friends. The meals appeared nutritionally balanced based around the people’s choices. EVIDENCE: People had particular interest in their lives. These were highlighted in their care plans and evident in their bedrooms and around the home. One person particularly enjoyed art and their paintings where hung around the house. Another person was interested in studying and languages and had taken several course and qualifications. One person was volunteering in the Jubilee Library in Brighton and another person was continuing her volunteering in an older persons home. Everyone had opportunities to access community facilities and one person in particular was very involved with his local Jewish community.
Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 12 Most people had active involvement with their families and friends visiting them regularly and having them come to their home. Some people were involved with day service and had friendships with other people who attended. The people who live at the home choose their meals in advance and draw up a menu and a rota for cooking. Each person takes turns to buy the food and contribute to the cooking. On the day of the visit one person came back from shopping with a staff member and showed the inspector what they had bought and where they got them from. The people spoken to on the day where able to describe the shopping and cooking routines and said they where happy with the current arrangements. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 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 The people who live at the home are supported to maintain their well being. They attend community health care appointments and have access to specialist health care provision. Preferences in the way people prefer to receive personal support are recorded. The medication procedures are clear and involved the people at the home. EVIDENCE: The people who currently live at the home require little support from the staff with personal care. When they do require assistance the staff demonstrated knowledge on how to deliver the support sensitively. The staff ensure that people have access to community health care facilities including mental health professionals if needed. Each person’s health check ups are monitored with the person and recorded in their care plans. The home encourages service users to administer and control their own medication where possible. The home has comprehensive information on the medications and their side effects and store’s and administers medication appropriately. During discussion with the deputy manager it was noted that several people are receiving support to maintain their mental well being. It was recommended that all staff attend mental health awareness training to ensure they have a good knowledge base to work from.
Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 14 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) 22 and 23 The organisation’s policies and procedures enable the people who live at the home and their representatives the opportunity to raise concerns and make complaints. The staff understood the complaints procedure and the process. The organisation operates within procedures to protect people from abuse. EVIDENCE: The complaints procedure contains the information needed for the people and their representative to make a complaint. The home or the Commission had not received a complaint since the last inspection. The manager has ensured that all staff have attended the Brighton and Hove City Councils training on Adult Protection. The deputy commented that she found the training useful and was able to describe the actions she would take if suspected abuse was reported to her. Since the previous inspection the manager and organisation has changed the way in which the people’s monies for rent are received by the organisation. The deputy produced an audit trail for the people’s monies that demonstrated that procedures are now in line with the Care Standards Regulations. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 15 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) 25 and 26 The people’s bedroom suit their needs and lifestyles and promote their independence. EVIDENCE: Each person has their own bedroom that is decorated and furnished to their requirements. The individual’s personality and interests are evident in each bedroom with personal belongings and hobby items on display. The people spoken to where happy with their rooms and facilities. One person said he used his bedroom to spend time on his own when he wanted to. Staff where seen to knock on bedroom doors and wait to be invited in. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 16 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) 32,34 and 35 The staff team were effective and met the support needs of the people who lived at the home. The organisations policies and procedures for recruitment of new staff are followed by the home. The people are protected by a robust procedure that meets the requirements in the National Minimum Standards. The organisation invests in the induction and training of its staff and the manager monitors each staff member through supervisions and staff meetings. EVIDENCE: All of the home’s staff has N.V.Q qualifications. The deputy went through the recent training she had undertaken which included adult protection training. She stated that if she felt she needed particular training in any area she could approach the organisation who would support her in the request New members of staff undertake induction and foundation training that includes training on working with people with learning disabilities. Since the previous inspection the manager ensures that all new staff have a C.R.B and P.O.V.A check before starting work. The deputy described the
Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 17 recruitment process and the documentation the organisation would seek from a new member of staff before they worked at the home. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 18 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) 37 and 42 The home was well run and the organisational ethos was reflected in the wider staff team. The home was a safe enviorment for the people who live and work in the home. EVIDENCE: The staff spoken to were complimentary about the organisational and managerial support. One staff member spoken to stated that the organisation was very supportive and that he had never experienced any problems with them. The staff had a clear view of the ethos of the home that the people were at the centre of the service. They felt that respect for the individual was paramount and each person should be given the opportunity to develop new skills and interest. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 19 The home conducts regular fire and health and safety checks. The manager also ensures that the people who live at the home are familiar with fire evacuation procedures. In June 2005 the staff held an evening drill where they recorded the response times of individuals and logged comments on how the evacuation went. The house is a none smoking house where those who smoke are expected to smoke outside. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9
Rachel Mazzier House Score 3 3 x 3 Standard No 24 25 26 27 28 29 30 Score x 3 3 x x x x
Version 1.20 Page 20 H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc 10
LIFESTYLES x
Score STAFFING Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 21 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 19 Good Practice Recommendations That all staff undertake mental health awarness training. Rachel Mazzier House H59 H10 S14228 Rachel Mazzier V220470 160605 stage 3.doc Version 1.20 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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