Inspection on 11/07/05 for Reeves Court

This inspection was carried out on 11th July 2005.

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 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Reeves Court 09/10/09

Reeves Court 30/10/07

Reeves Court 16/01/07

Reeves Court 30/11/05

Reeves Court 28/09/04

Reeves Court 29/06/04

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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 Reeves Court Reigate Road Leatherhead Surrey KT22 8NR Lead Inspector Helen Dickens Announced 11 July 2005 09:30 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. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Reeves Court Address Reigate Road Leatherhead Surrey KT22 8NR 01372 389410 01372 389416 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) SeeAbility Seeability House, Hook Road, Epsom, Surrey, KT19 8SQ Acting Manager - Richard Fairbank Care Home (CRH) 25 25 25 1 Category(ies) of Learning disability (LD) registration, with number Sensory impairment (SI) of places Dementia (DE) Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The age/age range of the persons usually to be accommodated wil be: 25 - 65 Years 2 The service may provide care in respect of one named individual within the category of Dementia (DE). Date of last inspection 12 October 2004 Brief Description of the Service: Reeves Court is located in the SeeAbility complex in Leatherhead, Surrey. It is close to local facilities and amenities. It was purpose-built and divided into four units, one of which is currently empty. Day to day management of Flats 1,2 and 4 is under the supervision of 3 deputy managers, all reporting directly to the manager. To the front of the building is a small pleasant patio area. Reeves Court provides care and accommodation for up to 25 residents in the category of younger adults. Residents have learning and sensory disabilities (visual impairment) and display some degree of challenging behaviour. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 7 hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. The inspection was carried out by Helen Dickens, Lead Inspector for the service. Mr. Richard Fairbank, acting manager, represented the establishment. Mrs.Joan Deeley and Mr. Paul Bott, representing SeeAbility, also participated. A full tour of the premises took place. The inspector met most of the residents and spoke with 5 in particular. In addition to the manager, one member of staff was also interviewed. Documents and files were inspected during the course of the day. The pre-inspection questionnaire and a number of returned ‘comment cards’ were also used to compile this report. This was a positive inspection. The inspector would like to thank the residents, staff, acting manager and senior SeeAbility managers for their time, assistance and hospitality during this inspection. What the service does well: The service provides a homely and safe environment for it’s residents. The flats were clean and tidy and residents appeared to be comfortable and contented. Residents were observed to be treated with respect and sensitivity throughout the inspectors visit. There were numerous examples of a high level of commitment from staff and a good understanding of the needs of residents. Independence of residents was being positively promoted. Those residents with whom the inspector was able to communicate indicated they liked Reeves Court and were happy there. SeeAbility caters for residents with visual impairments. The standard of attention to the practical difficulties encountered in relation to resident’s visual difficulties was excellent, and staff should be commended for their attention to detail in this regard. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Reeves Court H58 S36664 Reeves Court V226222 110705 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 Reeves Court H58 S36664 Reeves Court V226222 110705 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) 1,2,3,and4. Prospective residents can be sure that the pre-admission information available, and the assessments carried out, will ensure their needs can be met at Reeves Court. EVIDENCE: The pre-admission information for residents gives a good outline of the philosophy and care service available at Reeves Court. Examination of the files on recent admissions show that prospective residents have the opportunity to visit and then experience a ‘settling in’ period. One resident with particularly challenging needs had settled very well. The care manager’s review had complimented the service and said this would be used as an example of good practice. They also added that SeeAbility should be ‘proud of the work they have done’ with this client. The home demonstrated both in their practical support of residents, and in their record keeping, that residents needs were being met. One resident who had experienced many episodes of extremely challenging behaviour since admission was now settling down, mainly due to the time and attention given by the staff. There was good documentary evidence of this and a record of progress made. Reeves Court H58 S36664 Reeves Court V226222 110705 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) 6,7,8 and 9. Residents at Reeves Court can be confident that the care planning system is consistent and thorough and therefore more likely to ensure that their needs are identified and addressed. EVIDENCE: Individual care plans examined were detailed and thorough. They had been drawn up using assessments from external professionals as well as information gathered by the home. All residents had access to the rehabilitation workers based on site, to identify individual goals and support needs. Specialist requirements were identified and there were good records of appointments and outcomes. A member of staff has been given additional hours to review these plans with a longer term goal of making them more accessible to each resident. Regularly updated guidelines on dealing with the aggressive behaviour of one resident provided a good example of the consistent approach staff were taking to managing challenging behaviour within the home. Risk assessments on identified risks were available and had been regularly reviewed. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 10 Minutes of staff and residents meetings showed the extent to which staff were trying to involve residents in the day to day life of the home. Individuals were encouraged to make choices and decisions within their capabilities. One resident with a significant visual impairment was observed by staff when moving around and on each occasion was asked if she would like a ‘sighted person’ to accompany her. On the occasions when help was refused, staff respected this and offered verbal support only. During the inspection a number of residents were asked if they would like to show the inspector their rooms. Three residents refused and this was respected by staff without question. The inspector felt the self-esteem of residents was being enhanced by the approach and attitude of the staff at Reeves Court. Reeves Court H58 S36664 Reeves Court V226222 110705 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) 11,12,14 and 16 Residents quality of life is paramount at Reeves Court and the support they receive encourages their independence. EVIDENCE: Certificates displayed in resident’s rooms show the opportunities residents have had to learn life and social skills. The on-site rehabilitation worker sees all residents on an ongoing basis to review opportunities and encourage participation. In addition, a specialist worker for people with autistic spectrum disorders has been employed and is based in one of the flats. All the residents at Reeves Court have complex needs and these are addressed in their support plans. There is a day centre on site which some residents attend and there was evidence in residents files of both internal and external activities. One resident was observed to be playing his drum, accompanied by a volunteer on the piano. He was obviously enjoying this activity which was part of his scheduled programme. Other residents were encouraged to join in during this session. Staff were observed to treat residents with respect, asking their permission Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 12 and respecting resident’s refusal to participate. The acting manager, during the tour with the inspector, announced himself and introduced the inspector in each area and with individual residents. Residents with visual impairments cannot fully participate if they are not made aware of who else is in the room with them. There were no examples during the inspection of staff talking with each other to the exclusion of residents. Reeves Court H58 S36664 Reeves Court V226222 110705 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) 18,19,20 and 21 Reeves Court provides a good standard of health and personal care for its residents. EVIDENCE: There were many examples throughout the inspection of practical support being offered in a sensitive way to residents. Evidence of specialist advice was recorded on residents care plans. Residents chose their own clothes and style of dress. One resident showed the inspector her extensive range of necklaces, bracelets and hair accessories. There is a key worker system in place at Reeves Court and staff were knowledgeable about the residents they supported. Healthcare needs were very well documented and good records of appointments, outcomes and follow-ups were seen. Medication procedures had improved since the last inspection and evidence of staff training was shown to the inspector. However, a pharmacy company had contracted to visit and advise this home but no visits have so far taken place. The acting manager was asked to follow this up. In addition, the inspector noted there was some confusion about when to administer PRN (as required) medication. The guidelines for administering PRN medication need to be clear Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 14 and well documented on each resident’s medication record. Without clarity, staff will not be able to administer the medication in a consistent way. The previous inspector had highlighted the absence of a policy on ageing. Though a policy has since been drawn up there was as yet no evidence from staff that it had been implemented. This will be a requirement at the end of this report. Reeves Court H58 S36664 Reeves Court V226222 110705 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) 22 and 23 The complaints procedure and arrangements for protecting vulnerable adults at Reeves Court go some way towards safeguarding residents. However, additional measures need to be taken to fully meet these standards. EVIDENCE: The complaints procedure available is in a written word format and therefore not easily accessible for residents. A complaints folder with a tactile cover (displaying a slightly raised sad face) has been put in each lounge. Residents can then take the folder to a member of staff to show they wish to make a complaint. In addition the inspector suggested that the complaints procedure could be displayed more publicly for visitors to the home. The acting manager suggested putting a compliments and complaints book in the reception area and indeed had done this before the inspection was completed. There was a copy of the up-dated multi-agency procedures for the protection of vulnerable adults in each flat within Reeves Court. However, there was difficulty in finding evidence of staff training on this issue and it is not part of the SeeAbility induction training for new staff. The acting manager will need to clarify who has done the training and what arrangements will be made in the future to make sure all staff are familiar with procedures and their responsibilities in relation to the protection of vulnerable adults. Reeves Court H58 S36664 Reeves Court V226222 110705 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) 24,25,26 and 30 Reeves Court provides a well-maintained and homely environment for its residents. EVIDENCE: All residents have single rooms, and some have ensuite facilities. All rooms viewed where personalised and decorated to a good standard. However, one resident’s room had a long crack down the wall and this needs to be remedied. The home is divided into ‘flats’ so that there are three smaller groups of people living together rather than one larger group. In addition Flat 1 is divided into two halves and they live independently of each other. This was arranged to suit the needs of residents and to take into account their situation before they moved to Reeves Court. The home was clean and hygienic. The staff have had some challenges to maintain this when the needs of residents have at times compromised the otherwise high standards. The inspector was impressed by the sensitive and flexible measures being taken to meet this standard whilst safeguarding the privacy and dignity of residents. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 17 Reeves Court H58 S36664 Reeves Court V226222 110705 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) 32,35 and 36 Staff morale and commitment are high and this ensures a good standard of care and support for residents. EVIDENCE: Staff demonstrated they had the skills to support residents appropriately. Those spoken to had good knowledge of residents needs and were observed to communicate well with them. They were knowledgeable and had good procedures in place for dealing with aggressive and challenging behaviour. Staff met the fluctuating needs of residents very flexibly and three residents with the most challenging behaviours had improved since moving to Reeves Court. This was evident from care plans and earlier assessments, as well as from comments noted by professionals and relatives. The induction programme is detailed and gives new staff a good introduction to working with residents with visual impairments and learning disabilities. Staff commented that the training offered was good and SeeAbility were a good employer in that respect. In addition staff had recently had dementia training to enable them to meet the needs of a new resident. Some enthusiasm for this subject had been generated among staff who now wished to progress with further training in dementia. Staff supervision is regular and formal within the home and on the day of the Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 19 inspection the acting manager was seen to be offering a good level of support to staff. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 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 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) 37,38, and 42 There is an open and honest atmosphere within the home and residents benefit from the strong management and leadership at Reeves Court. However, the home will need to review some health and safety aspects of the service in order to fully protect residents. EVIDENCE: The registered manager left in May and an acting manager is running the home on a temporary basis until a replacement is recruited. The acting manager was very approachable and professional and was providing good clear leadership for the very committed staff team at Reeves Court. The acting manager was knowledgeable about the needs of residents and efficient in supporting the staff, especially during episodes of challenging behaviour from residents. Procedures were quickly reviewed and implemented to meet the changing needs of residents. Where safety certificates etc were difficult to find or out of date, the acting manager began to address the shortfalls whilst the inspection was still in progress. The acting manager will Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 21 need to submit an application to CSCI to vary the age range the home is currently registered to take. This is to accommodate existing residents who have already reached the upper age limit on the current registration certificate. On the day of the inspection there were a number of health and safety issues which needed attention. • Access to the upstairs staff room and the laundry areas in each flat need to be reviewed as they could be hazardous for vulnerable residents. A risk assessment was recommended for both. • Window restrictors need to be fitted to the upstairs bathroom windows and a review of the use (or absence ) of restrictors in other areas must be carried out urgently. • All water taps accessible to residents should be controlled to around 43C. Risk assessments should be carried out where there may need to be exceptions to this such as in the laundry and kitchen areas. • Risk assessments should be carried out for those residents who do not have emergency call systems in their rooms. Alternative arrangements should be risk assessed and well documented. Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 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 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 4 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x x x 4 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Reeves Court Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 1 x H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 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 YA6.7 Regulation 15(2)(a) Requirement Residents care plans should be made available to residents in a format which they can understand. The home should review and clarify guidance to staff on the administration of PRN medication. The home should contact the contracted community pharmacist and make an arrangement for them to visit and advise the home on their medication policies. The homes policy on ageing needs to be implemented as soon as possible. Staff should undergo training in the protection of vulnerable adults and a clear record should be kept. The crack in the wall in one residents bedroom needs to be repaired and the wall redecorated. The home should appoint a manager who should then apply to be registered with CSCI as soon as possible. The home needs to apply to CSCI to vary the age-range of residents to accommodate the Timescale for action 11.9.05 2. YA20.6 YA20.12 13(2) 11.8.05 3. 4. YA21.1 YA23.1 YA21.4 13(6) 11.8.05 11.9.05 5. YA24.1 23(2)(b) 11.9.05 6. YA37.1 YA37.3 8(1)(2) 11.8.05. 4 (1)(c Schedule Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 24 1, 5. 7. YA42.3 13(4) (a)(c) increasing age of existing residents. Regulation of water temperatures in all areas accessible to residents needs to be reviewed Provision of windows restrictors needs to be risk assessed and reviewed. Access to the upstairs staff room and to the laundry rooms needs to be risk assessed and reviewed. Risk assessments should be carried out for those residents who do not have access to the emergency call system in their bedrooms. Alternative arrangements need to be documented for each resident. 25.7.05 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 22 Good Practice Recommendations The complaints procedure should be made available in shared spaces within Reeves Court. This will remind residents and visitors about the procedure and reinforce their right to make comments and complaints. Details of CSCI and the availability of inspection reports should be highlighted in the same way. Copies of relevant policies and procedures should be translated into resident-friendly formats and displayed within the home. The inspector recommended that the complaints procedure and fire evacuation policy would be the most relevant to start. 2. 40 Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Reeves Court H58 S36664 Reeves Court V226222 110705 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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