Inspection on 23/05/07 for Regent House

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Regent House 09/10/06

Regent House 13/03/06

Regent House 28/11/05

Regent House 30/03/05

Regent House 12/08/04

Regent House 04/12/03

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

CARE HOME ADULTS 18-65 Regent House 28/30 Wellesley Road Clacton On Sea Essex CO15 3PP Lead Inspector Sara Naylor-Wild Key Unannounced Inspection 23rd May 2007 09:00 Regent House DS0000017918.V341389.R01.S.doc Version 5.2 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 Regent House DS0000017918.V341389.R01.S.doc Version 5.2 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. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Regent House Address 28/30 Wellesley Road Clacton On Sea Essex CO15 3PP 01255 421122 01255 431165 regenthouse@btinternet.com 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) Mrs Beatrice Owens Miss Suzanne Owens Mrs Joan Owens Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2006 Brief Description of the Service: Regent House is a care home for people with mental health conditions whose prime needs are for emotional support and care. Regent House is a three storey, detached property located in close proximity to Clacton town centre. All except one of the bedrooms are single occupancy and there is a choice of communal rooms. There is a small courtyard style garden to the rear of the property. The service charges between £254 and £498 per person per week for accommodation and care at the home. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection report represents information gathered up until the site visit to the home on 23rd May 2007. The information was collected from documents submitted to the Commission by the service in the Annual Quality Assurance Assessment, residents and health professionals feedback both at the site visit, in telephone conversations and in questionnaires sent by the Commission and discussion with the manager and staff during the visit to the home. Joan Owens the Registered Manager assisted the inspector at the site visit. Feedback on findings was given during the visit with the opportunity for discussion or clarification. The inspector would like to thank the Mrs Owens, the staff team, residents, relatives and professionals for their help throughout the inspection process. What the service does well: What has improved since the last inspection? The main concentration of the services development in the past year has been to understand how the introduction of the Mental Capacity Act 2005,impacts on way the service supports the residents living at the home. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 6 A comments box has been placed in the front lounge for anyone living and working at the home to place their views in anonymously. The manager hoped people would use the box for both positive and negative feedback. 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. The summary of this inspection report can be made available in other formats on request. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 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 Regent House DS0000017918.V341389.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that the service understands and is capable of meeting their needs prior to their admission. EVIDENCE: At the time of the inspection there were vacancies in the home, and the manager reported that they were receiving referrals for prospective residents, but there were not any new assessments to determine how this was carried out. Discussions with the manager and residents confirmed that prospective residents are assessed and invited to visit the home prior to moving in. The residents said that they had in the case of other admissions been consulted about the admission and if there had been significant issues the admission had not taken place. From discussions with the manager and other professionals involved with the service it was indicated that the life goals for the majority of residents was to maintain their present lifestyle with support from the service rather than any aim of independent living. Whilst in general the objectives of the Care Homes Regulations 2001 and the National Minimum Standards for Younger Adults, is to promote and enable individuals to take control of their lives, the limitations Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 9 to this must be clearly set out in the services Statement of Purpose and indicated in the individuals care planning documents. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that staff know and understand their needs. Although the care planning documents are not sufficiently detailed to support this knowledge. EVIDENCE: The files of four residents were examined as part of the case tracking methodology used by the Commission to understand the experience of residents living at the home. The care planning documents make up some of the file and the information held in these was considered to understand how this informs staff in meeting the assessed needs of residents. A brief summary sheet with the individuals’ life history, their likes dislikes and behaviours heads the documents. This provides a narrative of the resident with key points and provides a useful overview to staff to understand the general issues affecting the individual, but does not provide sufficient instruction to staff in how they are to support the individual. So for example one residents Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 11 heading sheet included this comment “X gets on well with the table they sits on but can become offensive and rude to others especially if they (X) feels others (Residents) are getting too much attention. X is on a low cholesterol diet and we buy then benecol as they loves cheese.” Additional records titled “Care planning history” had headings of current medical care, psychiatric care, mobility care, finances, behavioural, optician, dentist, diet, hygiene, social interests. In each section the record was broken down into Identified need, service user needs, goals identified and action The plan of one resident detailed that the individual had developed a habit relating to their belongings. Their care plan sets out that both their need and goal should be not to keep walking around with items. However discussions with a staff member indicate that in fact there are issues in the individuals past that are reflected in some of the items they keep with them, and that whilst they need help to manage the weight there are things that should not be removed from them. Similarly the care plan states that the resident needs supervision in personal care bathing, but does not detail how this happens. Discussions with staff indicate that the resident needs prompting with washing only. In discussions with staff it was clear that although the support required by other residents in respect of personal care their care plans described the same instructions. Overall there are plans of care, but these do not reflect the knowledge held by staff in meeting the individuals’ needs. This means the document is not person centred or reflective of the actual care offered by staff. The inspector discussed this issue with the member of staff responsible for care planning and also how the language of the current care plan prompts a focus on the individuals needs and problems rather than starting with their abilities and strengths that staff should seek to support and build their care around. The documents had some risk assessments for individuals’ daily living tasks they may need to undertake such as leaving the home. However the assessments were not undertaken in respect of abusive behaviours and how these should be managed. This is particularly important if staff are to intervene or have to restrain the individual. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to participate in activities of their choice, although the way in which the staff support this requires more consideration. EVIDENCE: In general residents spent time outside of the home independently. This included visiting drop in centres, clubs, church groups and the local town centre. Some residents spoken with were engaged in education opportunities such as IT. Discussions with the manager and residents indicated that there is reluctance for some residents to continue participation in outside activities. The care plans did refer to some of the initiatives used by staff to engage residents in activity however as with other areas of the plans the details in these could be greater. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 13 Records included information about the residents’ participation with family members, and how they are supported by the service. The home maintains a relaxed atmosphere where residents feel free to come and go as they pleased. They discussed with the inspector the general routine of the day and it was clear that there is flexibility in how the day is arranged with residents’ preferences taking a lead in this. One resident said, “This is the best place I have been in” Staff were observed interacting with residents throughout the day, and discussing a wide range of subjects. Residents enjoyed meals and the menu reflected their preferences. Discussions with the manager and residents indicated that a healthy diet was on offer as part of the menu and promoted with residents. The residents continued to participate in some meal preparation and said that they had enjoyed taking turns in the opportunity. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents can be confident that staff will understand how to best support them in their daily lives. Records that identify how residents should be supported are not person centred, and would benefit from further development. EVIDENCE: The care plan narrative in each residents file contained reference to the way in which they would prefer to be supported. Although this was not always fully set out there were some details to demonstrate that the service considered how residents’ preferences should be met The shortfalls already highlighted in care planning documents do not enhance the staffs understanding of residents’ mental health issues and how these should be supported. For example the care plan for a resident with abusive physical and verbal behaviour mentions that there is no known trigger to the Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 15 behaviour and that if agitated staff should ask if there is anything that can be done. Discussion with staff indicated that they understood issues that triggered the abusive behaviour and had learnt strategies to avoid issues that antagonised the resident. This level of information was not committed to the care plan. Similarly a significant health issue is recorded in the residents’ assessment sheet, but how this may affect their well-being or how staff should minimise the affect of this on their health is not detailed in care planning. Medication administration was considered at this inspection, Medication systems are operating robustly with recording in Mar sheets up to date. No residents are on controlled drugs but the staff were able to demonstrate they understand the systems for managing this. Staff responsible for administration of medication were able to demonstrate an understanding of the steps they would take when if colleagues were not adhering to the system. The residents’ documentation also included a record detailing their wishes in the event of dying and death. The sheet asks a series of questions about who they would like to attend at the terminal stages of their life and their funeral, how they would like to be treated following death i.e. cremation or burial and where this was to take place. It also asks if they want people to wear black, what music do you want played at the ceremony. All the residents had been offered the option of providing these details and in some cases very touching information was noted. This is an empowering and sensitive item to deal with and the record demonstrates a commitment to getting the residents wishes. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ views are listened to and the service is improving its responses to expressions of dissatisfaction. The protection of residents from abuse is supported by the homes policy and practice. EVIDENCE: The residents’ views are sought through questionnaires and meetings with staff and managers about the daily routine within the home, including the admission of new residents. Questionnaires returned as part of this inspection, relatives did not identify any complaints about the home. The Commission had not received any complaints since the previous inspection. Staff have attended training in Safe Guarding vulnerable adults Discussions with the manager indicated a clear understanding of what might be construed as abusive practice and what to do if they had any concerns. A safe guarding adults report made by the home to Essex Social services had evidenced this. Although the incident involving a resident took place outside the home the manager had understood the implications of the issue and had reacted promptly. Discussions with the Social Worker involved with the issue provided further evidence of the service good practice in relation to the protection of residents from abuse. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 17 Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in premises that are clean and maintained, but which could be developed to promote a more homely environment. EVIDENCE: Some areas of the premises and furnishings had been renewed from the last inspection visit and this gave a fresher and less institutional feeling to these rooms, and the manager detailed future planning in respect of updating communal rooms, principally the dining room that looks dated. The residents were observed freely moving about the home and taking parting activities such as knitting, reading and talking in different areas of the home. A service user who wanted to speak with the inspector in private made use of the front communal quiet lounge. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 19 The home appeared clean and free from odour on the day of inspection. Residents use an outside covered area for smoking. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by a staff group in sufficient numbers and with sufficient skills to meet their basic needs. Although further benefits would be provided to residents from development of the teams skills in understanding issues specific to their needs. EVIDENCE: Staff spoken with were clear about their roles and responsibilities. They understood the key worker concept and were able to describe in detail their understanding of the residents they were responsible for and how they supported them. In turn residents were aware of which staff member was key worker to them. The staff team is very stable and there is a good rapport between them and the residents. Staff records were looked at again at this inspection and from the sample considered there was evidence of a robust employment system where checks Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 21 are made on identity, previous employment and criminal records prior to employment. Staff supervision was more inconsistent than previously noted although the manager was aware of the shortfall. Training had taken place since the previous inspection and this included Medication training, moving and handling, food hygiene, MUST (Malnutrition Universal Screening Tool) etc. The manager has identified training in Mental Capacity Act 2005 Training as a future requirement of all staff. The majority of staff had completed their NVQ level 2 or above with the remaining group undertaking the course at the time of the inspection. The formal assessment of individuals training needs in relation to the development of the service continues to be an issue and although the training undertaken to date represents a range of issues relevant to health and safety the issues specific to mental health and the age ranges of the residents at Regent House are not represented. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from positive relationships with the management and staff team.They can be confident that they are consulted informally, but cannot be assured that their views are progressed. EVIDENCE: The manager has been in post for a number of years and has been responsible for the ongoing development of the service in this time. She holds the Registered Managers Award and is a NVQ assessor. The relationships between the staff and residents are relaxed and friendly with an easy but respectful rapport between the two parties. Residents spoke highly of staff and were aware of who their key worker was and whom they could Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 23 speak to if something was troubling them. There are regular meetings between the residents and manager and a suggestions box has been placed in the front lounge for residents to comment anonymously about the service. Overall the consultation with residents takes place in an informal manner and the service needs to develop their quality assurance system to provide residents with the information of the action taken in response to their comments. The manager acknowledged that the progress made in meeting the outstanding requirements made at the last inspection had been slow, with issues relating to the changes in Mental Health legislation taking a priority in the services development. This was reflected in the AQAA returned to the Commission prior to the inspection. The manager stated that she had not given the document her full attention prior to the completion date and had underestimated the complexity of the information required by the Commission. As a result the finished document submitted did not contain the full indication of the services evidence in meeting the Care Homes Regulations 2001 and how their future planning and development in their provision will enhance the quality of the service provision. The changes brought about by the Mental Capacity Act 2005 have been considered by the service and the manager and staff were developing their understanding of how they will need to incorporate this into their working styles. This has been the main focus of the learning and development in the service. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 3 3 X 2 X X 3 X Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 YA39 Regulation 24 Requirement There must be consultation with residents and other people involved with the service and the outcomes and plan developed from these must be published. This provides stakeholders with an opportunity to influence the way the home operates. Following consultation with each resident there must be an individual plan of care that details how their strengths, needs and wishes will be met. This will enable staff to be sure that they are supporting residents in an individual way. The registered person must consult with service users about, and make arrangements to enable their participation in, interests and activities. Timescale for action 31/08/07 2. YA6 YA7 YA9 YA18 YA19 15 30/09/07 7. YA12 YA13 16 30/09/07 13. YA35 YA42 18 The registered person must 31/10/07 ensure that, having regard to the needs of service users, staff receive training appropriate to the work they are to perform. Regent House DS0000017918.V341389.R01.S.doc Version 5.2 Page 26 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 YA24 Good Practice Recommendations The registered person should involve service users in planning improvements to the decoration and furnishing of the home. The statement of purpose should provide information that sets out how the service will operate and provides prospective residents with information to make an informed choice. Specifically the aims and objectives in relation to independent living. 2. 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