CARE HOME ADULTS 18-65
Reeves Court Reeves Court Reigate Road Leatherhead Surrey KT22 8NR Lead Inspector
Helen Dickens Unannounced Inspection 30th November 2005 10:00 Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Reeves Court Address Reeves Court Reigate Road Leatherhead Surrey KT22 8NR 01372 389410 01372 389416 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) SeeAbility To be confirmed Care Home 25 Category(ies) of Dementia (1), Learning disability (25), Sensory registration, with number impairment (25) of places Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The age/age range of the persons usually to be accommodated wil be: 25 - 65 Years The service may provide care in respect of two named individuals within the category of Dementia (DE). That the residents with dementia are accommodated on the same unit. That 5 residents may be aged up to 70 years. Date of last inspection 11th July 2005 Brief Description of the Service: Reeves Court is located in the SeeAbility complex in Leatherhead, Surrey. It is close to local facilities and amenities and next door to the Millennium Centre. It is purpose built and divided into four units, one of which is currently empty. Day to day management of the three Flats is under the supervision of three deputy managers, all reporting directly to the Registered Manager. At the time of writing, there is a new manager at Reeves Court, and she is currently registering with CSCI. 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 DS0000036664.V269522.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours and was the second 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. Alison Emms, Deputy Manager from Flat 1, represented the establishment. A tour of the premises took place. The inspector met most of the residents and spoke with five in more depth. In addition to the deputy manager, three members of staff were interviewed. A number of documents and files were also examined as part of the inspection process. This report assesses fewer Standards than the previous one, as the majority of Key National Minimum Standards were inspected during the July visit. This was a very positive inspection and the inspector would like to thank the residents and staff for their time, assistance and hospitality. What the service does well: What has improved since the last inspection?
Most of the requirements from the last inspection had been carried out including some care plans and contracts being put into formats residents can understand; clarification on the use of ‘as required’ medication has been obtained from a consultant; the complaints procedure is now available in the reception area; and the home’s policy on ageing has been implemented. A visit by the community pharmacist has provided a complete overhaul of the use of homely remedies at this home and details are contained in the main report. The home has recruited a new manager who has begun the registration process with CSCI. A number of new staff have been recruited and there was
Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 6 a positive atmosphere and confidence about further improvements which could be made now that the complement of permanent staff had been recruited. A number of improvements in the quality of life of some residents with particularly challenging behaviours were noted, and this is covered in more detail in the main report. Work is being started on health action plans and communication passports, and there was evidence of greater involvement from residents and their families in care planning activities. Staff have now started to compile more resident friendly records of resident’s holidays and special leisure activities. The format is in pictures and words and provides an enjoyable activity and reminder for residents now, but also a ‘history’ for the longer term. In one flat a number of residents were unable to go on holiday this year for health and other reasons, and extra items had been purchased to increase their leisure opportunities at home. The home is taking advantage of a MENCAP initiative ‘Listen Up’ and this is detailed later in the report. One flat had purchased a digital camera to improve their flexibility in recording activities both inside and outside the home. Some decorative work had also been carried out since the last inspection and baffle handles had been fitted to some doors upstairs as an alternative to window restrictors to protect residents. 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 DS0000036664.V269522.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Contracts at this home set out resident’s rights and are in a format which residents can understand. EVIDENCE: Contracts were examined on one of the three flats and found to contain the terms and conditions of each residents stay, and to be in a variety of formats. A taped version was available for those residents whose visual impairments would have prevented them from appreciating a written/pictorial format. Those residents who could not, for one reason or another, have their contract explained to them, had this documented on their files. It was also noted that on all of the resident’s files sampled, there was an up-to-date copy of the latest letter to each resident regarding fees for the coming year. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 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 Care planning at Reeves court is thorough and therefore residents can be confident that their needs are more likely to be identified and met. EVIDENCE: Four resident’s care plans were sampled from Reeves Court. Resident’s files each contains a sheet detailing those who had accessed the file and why, for example for CSCI inspection purposes, and for internal auditing. Care plans continue to provide a good overview of resident’s needs and plenty of additional information, advice and guidance for staff on resident’s special needs. The care plans show plenty of evidence of involvement from other specialists especially in relation to resident’s challenging behaviours and visual impairments. The inspector noted that there had been very significant improvements in the challenging behaviours of two residents in particular and staff were commended for their success in this regard. A member of staff is being funded for additional hours to work on care plans and is currently introducing health action plans. In addition, staff had obtained and started using the MENCAP toolkit ‘Listen Up’ which assists staff and residents to get together on a book setting out a resident’s likes and dislikes in a friendly format – one of these was examined as part of the inspection
Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 10 process and it provided a very helpful insight into resident’s support needs. Some care plans are read to residents, and some are in formats which residents could understand (e.g. Braille and on CD’s); however, the home should ensure that every resident has their care plan in a format which they can access. SeeAbility are currently revising their support plans for residents and it was suggested to the inspector that information could be added at the beginning of the written version for staff, saying how and where the plan is available, in an accessible format, for each resident. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 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): 13,15,16 and 17 Residents at this home are encouraged to be part of the local community, and to build and maintain their personal relationships. Their rights are respected in the day-to-day life of the home. Meals and mealtimes are well thought out, giving residents nutritious food and a pleasant experience. EVIDENCE: The SeeAbility complex in Leatherhead offers a ready-made community for those residents who live there or visit from outside. The day centre is next to Reeves Court giving easy access for those who wish to take part in day centre activities. The centre is open to those who live in residential care, supported living, or the wider community. This gives residents an opportunity to mix with a much wider group of people. On the evening of the inspection, some residents were going to a ‘chocolate party’ at the centre where they would have the opportunity to sample and buy some chocolate. Residents also have opportunities to be part of the wider local community for example each has their own personal shopping day each week, some attend college, and others prefer to get their hair done outside. Staff support residents to have family and friendship links inside and outside the home. There were good examples of families being welcomed and
Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 12 involved in the lives of residents. One relative had asked staff to take a photograph (with the home’s new camera) with the person she visited, and the results were very pleasing There were also good records of family involvement in care planning and reviews. Residents were free to develop personal and intimate relationships and staff outlined how they supported some residents in this regard. Staff were observed to be respectful to residents at all times. They were observed to knock on resident’s doors before entering and to interact well with residents. Numerous ‘arrangements’ had been made to promote residents independence and protect their rights. For example, the more independent residents had been given a ‘fob’, which opened external doors and allowed them free and independent access to the gardens. A resident who liked to use the swinging garden seat in all weathers had had this adapted to prevent him getting wet during the winter months. Another resident who was concerned about who was on duty and what food was on offer each day, has assistance from staff to record this information into a gadget every morning, which he can then play back during the day. He demonstrated how this worked and the independence it gave him. SeeAbility employs a ‘housekeeper’ for each flat and they are responsible for meals and mealtimes, working closely with residents and staff. The housekeeper in one unit was interviewed and found to be knowledgeable on special diets, the likes and dislikes of residents, and on special arrangements for eating. The lunchtime experience for residents on one unit was observed and it was noticeable how individually each resident was treated; where they liked to sit, how they liked their food to be presented, and how much support they required were all taken into account. All the flats were working on healthier eating for residents, choosing low fat options (one resident loved crisps but needed to loose a little weight) and more fruit and vegetables. It was noticeable how staff announced their arrival and departure on each unit, or when joining residents; this enables severely visually impaired residents to know who is in the vicinity at all times. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 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): These Standards were assessed at the previous inspection. EVIDENCE: Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 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 the following standard(s): 22 and 23 Complaints are taken seriously and resident’s views are taken into account. Experience with this home shows they deal well with suspected incidences of abuse, but staff are still not trained in these matters and this could potentially place residents at risk. EVIDENCE: This home makes sure residents are aware of how to complain and the ‘sensory’ version of the complaints procedure is available in each flat. There are also written copies in communal area such as in reception. Two small complaints received from residents on one of the flats had been noted and dealt with appropriately. The home has had some protection of vulnerable adults issues raised since the last inspection and these were dealt with appropriately. The acting manager followed the Surrey multi-agency procedures for the protection of vulnerable adults and kept in contact with CSCI on progress made. However, staff have still not received training on the protection of vulnerable adults and this is an outstanding requirement form the last inspection. The southeast Area Manager for SeeAbility, Paul Bott, who joined the inspection for the feedback at the end, said that staff had now been booked on a course in January 2006. SeeAbility should consider this matter as part of their induction training to ensure that staff who join after January 2006 are appropriately trained on this issue. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 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 the following standard(s): 24 Reeves Court provides a well-maintained, comfortable, safe and homely environment for its residents. EVIDENCE: The premises at Reeves Court are well maintained and on-going decorative work keeps it looking nice for residents and staff. Bedrooms were very individual and nicely decorated. One resident was very pleased to show the inspector his newly decorated bedroom with particularly neat arrangements around the windows where privacy screening had been fitted. The premises are accessible to residents and close to local amenities. Furnishings and fittings are of good quality and domestic in design. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 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 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): These standards were assessed at the previous inspection. EVIDENCE: Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 17 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): 37,39 and 42 Residents benefit from a well-run home. Quality assurance processes at Reeves Court ensure resident’s views are taken into account. The health, safety and welfare of residents are promoted at Reeves Court. EVIDENCE: The new manager at Reeves Court has the qualifications and experience to run the home and meet its stated purpose, aims and objectives; she is currently registering with CSCI. The interim manager and deputies should be commended for the way they have continued to make improvements at Reeves Court, despite the difficulty in recruiting a permanent manager. In addition, the majority of requirements and recommendations have been carried out and plans are in place to deal with those few remaining. On the day of this inspection the deputy from Flat 1 took responsibility for assisting the inspector and demonstrated a high level of professionalism, knowledge and commitment to Reeves Court. SeeAbility has an annual quality assurance audit where questionnaires are given to residents, staff and relatives. Key stakeholders such as care
Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 18 managers are also surveyed. Reeves Court also has monthly Regulation 26 audits, and a number of other ways of getting feedback from staff and residents, including monthly residents meetings, and regular team meetings for staff. The staff member drawing up resident’s support plans involved relatives and said they were ‘equal partners’ in resident’s care. He also outlined how residents had begun to be involved in future plans for this home. The information gained through all of these methods is used to draw up the home’s annual development plan. There were a number of health and safety issues raised at the last inspection which have now been addressed. Water temperatures were being regulated and monitored; all those tested on the day of the inspection were around 43C. Window restrictors have not been fitted to upstairs communal bathrooms but baffle handles had been put on the doors to prevent residents accessing these rooms when unaccompanied. New guidance had been given to staff regarding residents who do not have access to, or cannot operate, call bells in their rooms at night. Some residents have sensors on beds and doors for example to enable staff to monitor their safety. However, risk assessments still need to be carried out and alternative arrangements made and documented for all residents. This is outstanding from the last inspection. The hazardous substances rooms on each Flat were secure. There was documentary evidence of weekly ‘visual;’ checks for fire hazards including overloaded electrical sockets and up to date ‘PAT’ testing of appliances. The inspector noted there was a chlorination certificate (legionella safety), a gas safety certificate, and a current electrical wiring safety certificate. All staff attend a food handling and hygiene course within 6 months of starting work with SeeAbility; all staff are potentially involved in food handling giving residents breakfasts and suppers outside normal housekeeping hours. Fridge temperatures on individual units were monitored and within normal limits but one fridge contained items which had been opened but not date labelled. The fire safety officer letter on file said that the home was safe as long as all the recommendations made at the 2002 fire safety inspection had been carried out. On the day of the inspection it was not possible to determine whether these recommendations had all been completed and a requirement will be made in this respect. One of the recommendations had been to carry out a Fire Risk Assessment and this had been done, and reviewed by the interim manager in May 2005. The deputy manager said fire practises were carried out with residents four times per year, including one at night. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 19 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 X X X 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X x LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Reeves Court Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 x DS0000036664.V269522.R01.S.doc Version 5.0 Page 20 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 YA23 Regulation 13(6) Requirement All staff should receive training in the protection of vulnerable adults. This outstanding from 11.9.05. SeeAbility must consider including this subject in their induction training from now on. Perishable foods kept in the refrigerator should always be labelled once opened. Risk assessments should be carried out with regard to those residents who cannot access emergency call bells within their rooms. Alternative measures should be clearly documented. This is outstanding from 27/07/05. This information should be sent to CSCI within one month. The home should provide to CSCI, in writing, confirmation that the recommendations of the fire safety officer’s report in 2002 have now all been met. Timescale for action 15/01/05 2. 3. YA42 YA42 13(4)(a) 13(4)(C ) 02/12/05 01/12/05 4. YA42 23(4)(a) (b)(c) 01/01/06 Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 21 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 YA6 Good Practice Recommendations The home should ensure that every resident has a service user plan in a format which is accessible to them. Reeves Court DS0000036664.V269522.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Surrey Area Office 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
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