CARE HOME ADULTS 18-65 SARESTA AND SERENADE Bromley Road, Elmstead Market Colchester Essex CO7 7BX
Lead Inspector Ray Burwood Final Unannounced 04 May 2005 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. SARESTA AND SERENADE Version 1.10 Page 3 SERVICE INFORMATION
Name of service Seresta and Serenade Address Bromley Road, Elmstead Market, Colchester, Essex, CO7 7BX. 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) 01206 827034/825779 roydias88@hotmail.com Mr Rohan Vasantha Kumara Dias, Mrs Velamba Dias Ms Karon Bosher. Care Home. 10 Category(ies) of Learning Disability (10) Physical Disability (10). registration, with number of places SARESTA AND SERENADE Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who also have a physical disability (not to exceed 10 persons). Date of last inspection 30th November 2004 Brief Description of the Service: Seresta and Serenade is a home providing care and accommodation for 10 individuals with learning disabilities, some of whom may have a physical disability, between the ages of 18 and 65. The home is owned by Mr and Mrs Dias and is one of a small consortium of homes in the area. The Manager of the home is Ms Karon Bosher. Accommodation is provided in two separate bungalows, each offering single bedrooms for 5 individuals. Each bungalow comprise living accommodation, kitchen and own laundry facilities. There is a small patio area situated between the two bungalows and a large garden area at the rear of the two bungalows. Seresta and Serenade is situated in a small village close to local facilities. There is adequate parking facilities at the front of the bungalows for staff and visitors. SARESTA AND SERENADE Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on the 4th May 2005 with the assistance of the Manager, staff and service users. The inspection was carried out between the hours of 9.30 am and 2.30 pm. Service users and members of staff were spoken with. Parents of service users’ and the Community Nurse (Epilepsy) were contacted by telephone and provided positive feedback about the service. Although the complex needs of the service user group made communication difficult, it was apparent that they were happy, contented and there was positive interaction between staff and other service users. A total of 20 standards were inspected with 16 being met. The remainder, one requirement and three recommendations, were repeated from the home’s previous inspection. A tour of both bungalows was undertaken and both care and staff records were inspected. Due to pre-arranged appointments and activities, most of the service users and staff were out of the home together with the manager, however, there was still the opportunity to speak to staff and one service user that had remained at the home. Areas discussed with staff included training, supervision, key-worker responsibilities and the care of service users. What the service does well:
The service provides a committed key-work system, a good communication network with other professionals and the families of service users. Service users’ healthcare needs were seen to be well met through the case tracking process. Relevant records were found to be up to date. Care Plans are closely monitored, reviewed and appropriate referrals made. Staff spoken with confirmed that the service provided excellent training opportunities and they were receiving positive support and guidance from the home’s manager. Relatives and healthcare workers contacted during the inspection process referred to the close working arrangements with the home and the positive outcomes this had for the service users. The service provided a welcoming environment that had been furnished, decorated and maintained to a high standard to meet the needs and lifestyles of both groups of service users.
SARESTA AND SERENADE Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
Service users’ take part in fulfilling activities, however, further progress could be made in widening the areas of activities for some service users’ in order to improve their personal development. If it is possible, the home could make use of local educational and Day Centre resources for some individuals. The home should ensure that people actively making decisions on behalf of service users’ sign contracts/agreements, care plans and any other relevant documentation. Further enrolment of staff onto the NVQ training course would ensure a more skilled care team to meet the complex needs of the current group of service users. SARESTA AND SERENADE Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. SARESTA AND SERENADE Version 1.10 Page 8 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 SARESTA AND SERENADE Version 1.10 Page 9 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) 5. Service users had individual written contract of terms and conditions with the home, however, these contracts should contain signatures ensuring that the service user or their representative know what services were being provided by the home. EVIDENCE: The contracts of residency for three service users were sampled and found to include details of the services provided by the home. At the time of the inspection the home was consulting service users families regarding the agreements and the signing of contracts. SARESTA AND SERENADE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 8. Service users’ healthcare is well met with records in place to provide evidence of this. Parents and relatives support the home through being part of the reviewing process. Independent advocacy is available to further support service users’ and relatives if required. EVIDENCE: Care plans sampled were seen to contain the information regarding the assessed and changing needs of service users, thus enabling staff to carry out their care duties. Care plans were reviewed on a regular basis by key-workers. Staff and relatives spoken with confirmed that any changes to care plans were discussed and agreed. There was no evidence of this in care files inspected. Care plans contained details of service users likes and dislikes, these formed the basis of decisions made on behalf of the service users who were unable to make decisions about their lives because of their incapacity. SARESTA AND SERENADE Version 1.10 Page 11 Care plans set out how current and anticipated specialist needs will be met and specialist agencies noted to have been involved. Comprehensive risk assessments were detailed and included in care plans inspected. From discussions with members of the care staff team, it was confirmed that service users are appropriately supported by their families and if there is a need for an independent advocate, families would be advised. Service users who were able contributed and participated in the daily running of the home. This included the planning of menus and shopping for food. One service user communicated her choices through a visual aid that included most of the signs associated with daily living. SARESTA AND SERENADE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 and 17. Service users were encouraged and supported to take part in fulfilling activities of their choice, both in the community and in the home environment. Daily routines in both bungalows were flexible and there was positive support in promoting service users independence and choices. The quality and quantity of food met individual needs. Meal times were observed to be relaxed and flexible to suit service users activities and schedules. EVIDENCE: None of the current service user group are able to take up the opportunity of employment due to their complex disabilities. Care plans contained the likes and dislikes of service users in relation to activities, most of which involved group activities. Two service users had a dedicated worker who provided a one to one service and some individual activities. From discussions with staff and care plan records inspected, no service user attended outside educational courses or attended local Day Centre resources. All service users had a programme of fulfilling external activities that included: • Trampolining,
SARESTA AND SERENADE Version 1.10 Page 13 • • Hydrotherapy, Aromatherapy, A choice of entertainment was available in the home through videos, games, television and music. From discussions with staff and service user’s families, family links were very strong and supported by the home. Parents of service user’s contacted during the inspection period were complimentary about the home’s open door policy and how welcome they are at any reasonable time of day or night. The home operates a weekly rotational menu whilst at the same time recognises individual choices and alternatives. Each bungalow has a small domestic style kitchen adequately equipped to prepare meals and snacks. SARESTA AND SERENADE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19. The homes healthcare arrangements regarding the physical and emotional needs of service users were met and appropriately documented. EVIDENCE: Three service users’ files were sampled. From the evidence seen their physical and emotional health needs were being addressed and met, with detailed records kept. During the inspection it was noted that an appointment with a Consultant Psychiatrist was taking place. This was following a referral from the Outreach Team, who supported people with a learning disability within the home’s geographical area. Discussions took place with a parent of a service user who commented on her sons’ period of illness and the specialist care and support he received. This highlighted the joint arrangements between the home, families and healthcare professionals in producing a successful outcome. All service users’ are registered with a General Practitioner in the village. SARESTA AND SERENADE Version 1.10 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) 23. The homes Adult Protection Policy and Procedures, including staff training and recruitment practices, promoted the protection of service users from harm or abuse. EVIDENCE: The home’s Adult Protection Policy and Procedures (including Whistle Blowing) were comprehensively detailed. Staff spoken with confirmed that they were aware of the procedures and had received training in Adult Protection and Challenging Behaviour. SARESTA AND SERENADE Version 1.10 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) 24,26,and 30. The home provides a safe and well maintained environment. Both bungalows visited were homely, clean, tidy and free from any offensive odours. All areas were accessible and meets individual needs and lifestyles. EVIDENCE: During an inspection of the premises it was noted that each bungalow was homely, comfortable and provided a safe environment for service users. Each bungalow was accessible and maintained to a good standard. Bedrooms were furnished with a mixture of personal items chosen by individual service users, their families and what the home provided. Information was shared with the home’s manager regarding what is required in terms of how the home should comply with water regulations ie, through regular checks on hot water supplies in order to prevent Legionella. On the day of the inspection the bungalows were clean and tidy and free from any offensive odours. SARESTA AND SERENADE Version 1.10 Page 17 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) 32,33,34 and 35. Staff training is provided in a planned way, to meet the needs of service users.Staffing levels at the home have been maintained through some management hours used for care cover, and minimal amounts of overtime worked by staff. The homes recruitment procedures were robust and ensured the protection of service users EVIDENCE: The home currently has three care staff that are NVQ qualified, with a further two of whom are close to completion. In addition staff are undertaking the Learning Disability Award Framework-accredited training to underpin their knowledge for progress towards achieving R/NVQ. Since the last inspection two qualified members of staff had left, leaving the home with the task of recruiting additional staff onto NVQ training, to ensure that sufficient staff are qualified by 2005. Staffing levels and skill mix of staff on duty were found to be adequate with two service users having additional hours provided, following a re-assessment of their needs. Delegated workers maintain a one to one individual support programme for these hours. Staffing levels had been determined according to the assessed needs of individual service users’, in accordance with the
SARESTA AND SERENADE Version 1.10 Page 18 Department of Health guidance. The manager discussed the need to provide more staffing to enable more quality time. Currently the home has vacancies for 1.5 posts. No agency personnel are employed by the home at present. Staff files were sampled in respect of the home’s recruitment process. All files contained the documentary evidence required under Regulations. SARESTA AND SERENADE Version 1.10 Page 19 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) 39,42. The homes quality assurance and monitoring systems were in place to ensure that the development of the service is ongoing and reviewed regularly. Records required for the protection service users and others were in place and secure. EVIDENCE: Since the last inspection the home’s manager had submitted an Action Plan in respect of the home’s Quality Assurance. This document reflected the aims and outcomes for service users following stakeholder surveys’ and subsequent feedback A range of safety certificates and records associated with internal checks, including fire procedures, were viewed and met the regulatory and Health & Safety requirements for the protection of individuals. SARESTA AND SERENADE Version 1.10 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 2 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 x x x 3 Standard No 11 12 13 14 15
SARESTA AND SERENADE x 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 2 2 3 3 x Version 1.10 Page 21 16 17 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x SARESTA AND SERENADE Version 1.10 Page 22 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 YA5 Regulation 5 Requirement The registered person must ensure that the service users or their representatives sign their contract of terms and conditions.( Previous timescale of 31/01/05 not met). Timescale for action 31/07/05 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. 2. 3. 4. Refer to Standard YA7 YA14 YA32 Good Practice Recommendations The registered person should involve and record, the choices/decisions made by others, on behalf of service users, and their signatures placed on file. The registered person should ensure that the cost of all service users holidays are met from within the basic contract price. The registered person should ensure that the appropriate numbers of care staff achieve National Vocational Qualification (NVQ) Level 2 by 2005. THE ABOVE 3 RECOMMENDATIONS ARE REPEATED FROM THE HOMES PREVIOUS INSPECTION 30/11/04 SARESTA AND SERENADE Version 1.10 Page 23 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex C01 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 SARESTA AND SERENADE Version 1.10 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
