Inspection on 09/10/06 for Regent House

This inspection was carried out on 9th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Regent House 23/05/07

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 Jenny Elliott Key Unannounced Inspection 9th October 2006 09:00 Regent House DS0000017918.V314047.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.V314047.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.V314047.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.V314047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 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.V314047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information for this report was gathered from observation and discussion with staff and service users at a site visit to the service on 9th October 2006. In addition information received by the Commission since the last inspection and questionnaires completed by service users, relatives and general practitioners was taken into account. What the service does well: What has improved since the last inspection? What they could do better: The home should develop plans with service users, that cover all areas of their health and welfare to ensure that care is consistently and appropriately provided. The home must ensure that it carries out sufficient checks before appointing staff to protect people living at the home. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 6 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. Regent House DS0000017918.V314047.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.V314047.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 This outcome area could not be fully assessed as no new service users had moved into the home. EVIDENCE: No new service users had moved into the home since the last inspection, there was therefore no opportunity to inspect current practice in respect of preadmission assessments. The manager advised that people living at the home had been consulted following the receipt of a referral for someone who was known to a number of existing service users. Existing service users said they did not want this person to move in, and so the referral was not progressed. This was not recorded in the notes of service user meetings, but in discussion some service users said they were consulted before new people moved into the home. This practice is also stated in the homes Statement of Purpose. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Plans of care in place at the home did not promote opportunities for service users to make decisions, participate in the running of the home or to take risks, but care practice did. Plans of care at the home did not provide clear guidance for staff in respect of the health and welfare support needs of service users. EVIDENCE: Records belonging to three people living at the home were inspected. This included plans of care. The plans did not address all of the areas required under National Minimum Standards, and did not provide clear guidance for staff. For example once care plan said that a persons needs were ‘help with pushing …wheelchair to take … out’ and under the heading Goals Identified, ‘no goals to achieve as … is happy’. For another person, whose needs had been identified as depression and budgeting, the guidance for staff read ‘encouragement on how to budget, reassurance and support’. These examples Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 10 do not demonstrate that the individual support needs or aspirations of service users have been clearly identified. There was other evidence in the daily records sheets that one of the people, whose records are given as an example above, liked to help around the home with tasks such as setting the table and putting shopping away, they also told the inspector they liked to ‘go out for coffee’, none of these things were in the persons care plan. One of the people living at the home told the inspector that ‘[another service user] fed the homes cats’. One set of records identified that a person was risk of taking an overdose, from buying painkillers over the counter. The risk management strategy was to restrict the persons opportunity to purchase anything for themselves, rather than supporting the person to make positive decisions about what they purchased. However, further discussion with the service user and staff suggested that the person did in fact have opportunities to make some decisions about how they spent small amounts of money. This was considered a positive approach, and should be reflected in the risk management strategy. Discussions with staff about the support needs of the people referred to above, revealed a greater level of understanding of those individuals than the plans of care suggested. It was not clear though, how the home ensured that support was provided in a consistent manner or how people living at the home were encouraged to attain personal goals and aspirations. One member of staff spoken to at the inspection demonstrated good practice in respect of maintaining confidentiality. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 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): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not enable all service users to maintain appropriate and fulfilling lifestyles. Food was well presented by the home, but did not necessarily meet the needs of all service users. EVIDENCE: Many of the people living at the home spent some part of the day outside of the home, and many people did not need the support of staff to do this. Some people were reluctant to go out, and at least one person had mobility difficulties that meant they needed the support of staff to go out. On the day of the site visit the manager advised that one person was at a drop in centre and another person at a workshop, that three people went to college and a couple of people went to church. This range of structured activity is considered to be fairly low for a group of 20 people, most of whom have the skills and/or physical ability to leave the home without support. Plans of care did not address this area of support sufficiently. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 12 One of the set of records inspected demonstrated that the service user was supported to maintain links with their family. The service user confirmed this, telling the inspector about the visits they made. There was a relaxed atmosphere at the home during the inspection. It was clear that service users were used to coming and going freely. Although there was a fixed lunchtime, one of the service users told the inspector ‘they [staff] will do you a sandwich in the evening if you want one’, and other records suggested that routines for getting up and going to bed varied according to the preferences of individuals. Staff were observed interacting with service users throughout the day, and discussing a wide range of subjects. There was a pleasant and relaxed atmosphere at lunchtime. Service users sat in small groups and were offered a choice of meals. The meals were well presented and included a homemade quiche. After dinner staff served tea and coffee. A number of people living at the home commented positively on the food provided. One person said ‘the food is really good here’. One service user said they had done a bit of cooking at the home, and during the inspection was talking with staff about helping to make the Christmas cake ‘again’. A member of staff advised that a few service users had completed food hygiene certificates and ‘done some cooking in the kitchen’. The menus were inspected. People living at the home have a diverse range of nutritional needs. The home accommodates people who rarely move from their room and are vulnerable to illness associated with old age as well as younger more active people, and younger less active people. The menus regularly included chips, crispy pancakes and potato wedges, and much less often soups and salads. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer. Service users physical and emotional health needs were not fully met. Service users were not fully protected by the practices in the home for the administration of medication. EVIDENCE: As has already been stated staff were able to describe in detail the different needs, likes and dislikes of people living in the home. The interaction observed was appropriate and carried out in a manner that maintained the dignity of individuals. Little of this was detailed in care plans, although one service user had specific wishes about their funeral and these were clearly detailed. People living at the home have support needs in respect of their mental health. The records inspected did not identify behaviours that could indicate a relapse, even where these were identified in the referral papers for one person. Two of the records seen included statements that the people refused to see the Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 14 optician and/or the dentist. There was no record of what steps the home had taken to encourage the person to visit these services or to seek out alternative ways of providing these services. One of the people living at the home told me they had put on too much weight. A member of staff told me they were ‘aware of … weight problem’ and ‘wanted a diet sheet from the Doctor.’ At lunchtime this service user told the inspector they got their dinner early ‘because staff said I looked hungry’. This person’s plan of care included the statement ‘no special dietary needs.’ It was not evident therefore, in practice or planning that health needs were fully met. One service user had had their medication reviewed just before the inspection. One record held information about indicators that would suggest a relapse in respect of their mental health needs, but this was dated April 2004 and their was no evidence that this had been reviewed. The controlled drugs cupboard did not meet the recommended standard of the Royal Pharmaceutical Society, and there was no separate record for the administration of controlled drugs. There were no gaps identified in the records inspected in respect of other drugs administered at the home. Three people living at the home are responsible for their own medication, and each has lockable storage in their bedroom. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted upon. Service users are not fully protected from financial abuse. EVIDENCE: There were practices in place to elicit the views of service users through questionnaires and meetings about day-to-day issues within the home, including the admission of new service users. Staff were observed engaging with service users in a meaningful way. Service users spoke highly of the staff at the home. In questionnaires returned as part of this inspection, relatives said they had not made any complaints about the home. The Commission had not received any complaints since the previous inspection. The vast majority of staff had attended training in respect of the protection of vulnerable adults since the previous inspection. In discussion staff were clear about what might be construed as abusive practice and what to do if they had any concerns. Practice in respect of the handling of service users finances were not sufficiently robust as receipts were not available to evidence expenditure. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation was homely and comfortable. Some furnishings and decoration were in need of attention. The premises were clean and hygienic. EVIDENCE: The home was largely clean and tidy. There was a slight odour in the dining room but none noted elsewhere in the home. Some furniture looked tired, with torn and frayed covers to arm chairs. Two bedrooms were visited during the inspection. One room had little floor space, and insufficient room for an armchair, because of the amount of personal belongings stored on the floor. The manager advised that this service user was discussing with their keyworker how shelves could be used to store and display some of those items. The person who lived in this room said they were happy with their room and preferred to sit on the bed anyway. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 17 The manager advised that there were plans in place to decorate the dining room and the lounge (by the office) next. The flooring of the dining room was stained and torn in areas. The dining room also had a bar, with shutter that gave an institutional feel to the room. Service users said this was not used much. The staff areas (office and sleep-in room) were much brighter and more contemporary than the rest of the building. The home accommodates people of quite a wide age range and should consider how to involve people in choosing the decoration and furnishing of the home. There is a paved area to rear of property, with a fishpond and rockery, and covered seating area used by people who lived at the home to smoke. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The training and development of staff was not directly related to the needs of people living at the home. Service users were not sufficiently supported or protected by the homes recruitment practices. EVIDENCE: Staff described the role of a key worker was ‘for clients to know they have a special person they can work with.’ There were dedicated domestic staff for cleaning and cooking and no staff vacancies at the time of the site visit. There was a stable staff team at the home, who had a good level of knowledge about the needs of people living there. Of the 14 care staff employed, 6 had completed a National Vocational Qualification (NVQ) in Care at level 2. Two senior carers had achieved and NVQ in care (Level 3) and two were working towards completion of that award. The manager advised that all but two members of staff had completed Local Authority Protection Of Vulnerable Adults (POVA) training, and this was confirmed by staff. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 19 Records relating to three staff were looked at. One person had commenced work before a Criminal Records Bureau check or POVA first check had been recieved, and their records only included a verbal unsigned reference. No training needs assessments were on the files. There was evidence that training had been undertaken although some key areas had been completed two years previously, and one person had not attended a drug handling course since March 2000. There was no assessment of training needs required by the home to meet the assessed needs of people living there. There was evidence on the staff records that regular supervision was held, but the notes from those meetings did not include monitoring of work with individual service users. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. There was not an effective quality assurance and monitoring system in place at the home. The home protected service users through the regular maintenance of equipment and services. Not all staff had undertaken current training in respect of health and safety issues. EVIDENCE: Staff said they liked the manager one person said she had ‘good personal relationship skills’ and ‘brings staff and clients together’. The atmosphere at the home on the day of the site visit was relaxed and homely. The interaction Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 21 observed between the manager, senior staff and care staff was positive and supportive. The manager of the home has considerable experience and has completed her NVQ level 4 Registered Managers Award. Service user questionnaires had been used to gather information about the service. The questionnaires did not explore what would make the service better and so there was no development or improvement plan in place. No one else had been consulted about the service provided by the home. The Fire officer had visited in the previous 12 months. There was evidence that fire fighting equipment and emergency systems had been tested at appropriate intervals. A fire risk assessment originally from June 2003, had been reviewed and updated, the most recent update was in June 2006. Other records held at the home showed that safety checks in respect of electricity and gas were also in order. As stated in the previous section, there was no clear training plan in place at the home or clear requirements in respect of when training should be updated. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 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 2 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 1 35 2 36 X 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 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 3 3 X 1 X X 2 X Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 23 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 YA7 YA9 YA18 YA19 YA12 YA13 Regulation 15 Requirement The registered person must develop, in consultation with service users, a plan of care that details how their needs will be met. The registered person must consult with service users about, and make arrangements to enable their participation in, interests and activities. The registered person must provide, in adequate quantities, suitable, wholesome and nutritious food. The registered person must make arrangements for the recording, handling, safekeeping safe administration and disposal of medicines (including controlled drugs) received into the care home. The registered person must make arrangements to prevent service users being placed at risk of abuse, including financial abuse. The registered person must not employ a person to work at the home until information required DS0000017918.V314047.R01.S.doc Timescale for action 31/01/07 2 16 31/01/07 3 YA17 16 31/12/06 4 YA20 13 31/12/06 5 YA22 13 30/11/06 6 YA34 19 30/11/06 Regent House Version 5.2 Page 24 7 YA35 YA42 18 8 YA39 24 by regulation is obtained about that person. The registered person must 31/03/07 ensure that, having regard to the needs of service users, staff receive training appropriate to the work they are to perform. The manager must develop 31/03/07 quality assurance and quality monitoring systems for the home. This is a repeat requirement. 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. Regent House DS0000017918.V314047.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Regent House DS0000017918.V314047.R01.S.doc Version 5.2 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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