Inspection on 01/02/06 for Sarsen House

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sarsen House 21/11/06

Sarsen House 14/09/05

Sarsen House 16/03/05

Sarsen House 12/07/04

Sarsen House 26/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Sarsen House West Overton Marlborough Witshire SN8 4ER Lead Inspector Tim Goadby Unannounced Inspection 1st February 2006 15:00 – Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sarsen House Address West Overton Marlborough Witshire SN8 4ER 01672 861139 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) Tullyboy Homes Mrs Catherine Howie Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2005 Brief Description of the Service: Sarsen House provides personal care and accommodation for six people with a learning disability. The service is owned by Tullyboy Homes, a private sector organisation. They run another similar home elsewhere in Wiltshire. Both owners have close involvement in all aspects of service delivery. Another senior staff member also participates in joint management of the two homes. The home is in the village of West Overton. This is approximately three miles from the town of Marlborough, which offers a range of amenities. The service first opened in 1995. Most of the service user group have lived at Sarsen House from that time. They also knew each other for many years beforehand. The property is a two storey house. A ground floor extension has been added since it became a care home. All service users have single bedrooms. Two of these have en-suite facilities. Others have access to bathroom and toilet facilities nearby. There is a range of communal space. The home also has a large garden. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in January 2006. A total of 3.5 hours was spent in the home. The following inspection methods have been used in the production of this report: indirect observation; pre-inspection questionnaire, completed by the provider; sampling of records; discussions with service users, staff and management; tour of the premises. The two homes operated by Tullyboy were both inspected on the same day. Findings have been applied to both services, where appropriate. What the service does well: What has improved since the last inspection? Information has been updated within relevant records about a restrictive practice used with one individual. Current documentation is clearly and Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 6 coherently presented. Guidelines have been amended to reflect accurately the current pattern of usage of the practice. There is evidence of a multi-agency focus on the issue, with regular review. This helps to ensure the welfare and protection of the individual service user concerned. 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. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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): 3 Service users have their needs and aspirations met by the home. EVIDENCE: Most of the current service users have lived at Sarsen House since it first opened. They also knew each other for many years beforehand. As a well established group, they appear settled and happy. The service has developed a strong knowledge of their needs. There is also a focus on continuing to promote new opportunities and experiences. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 9 Equally, the service has demonstrated a successful approach to the admission and assimilation of new residents. The home has been able to meet the needs of these individuals, whilst continuing to support those of more longstanding service users. The newest person has settled well, and is benefiting from the care provided. Problems experienced in a previous setting have reduced significantly. The Tullyboy staff team bring various areas of expertise. Support is also accessed from a range of other professionals and agencies. The needs of the home’s service users are changing over time. This is mainly due to the ageing process. This can affect people with learning disability earlier in life than for the general population. Both physical and mental health may be affected. Sarsen House is adapting to meet these changing needs as far as possible. For instance, staffing is being kept at three per day to reflect the higher support required by some individuals. There is also a recognition that further resources may be needed in future. The service is liaising with relevant agencies to keep them updated about the way people’s needs are developing. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 the following standard(s): 7 Service users are supported to exercise choice and control in all aspects of their daily lives. EVIDENCE: The home promotes people’s rights to make their own choices and decisions, wherever possible. A Users’ Charter sets out their entitlements. Experimentation and exploration are encouraged. The input of the home’s staff team, and other relevant parties, is to ensure that responsible decisions are reached by a process of assessment. Guidelines for the approach taken to particular needs are drawn up with help from other professionals. Systems for the management of service users’ money appear to be efficient. The registered manager acts as corporate appointee. Appropriate recording is in place to demonstrate the home’s accounting systems. These are open for inspection, if relatives wish it. They are also checked annually by an external accountant. Arrangements for direct payment of service users’ benefits income are in line with guidance set out by the CSCI. The account used for this purpose is kept Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 11 separate from the main business account of the home, not forming part of its assets. Also, the account records are itemised, to show separately deposits and withdrawals for each individual service user for whom monies are received. A particular restrictive practice is operated with one service user. Care standards legislation allow the possibility of such an approach, if it is the only practicable means of securing the individual’s welfare. Recently there has been extensive review and consultation around this issue. The individual’s care record now contains far more supporting information about the use of the technique. Decision making has been shared, to enhance the protection of the vulnerable individual. The practice is being kept under regular review. Information has been further updated within relevant records since the previous inspection. Current documentation is clearly and coherently presented. Guidelines have been amended to reflect accurately the current pattern of usage of the practice. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 16 & 17 Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Daily lives for service users have an appropriate balance between necessary routines, and individual choice. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 13 Service users attend various educational and occupational activities during the week. Staff from the home may support some of these sessions. Some individuals are not able to attend every time, depending upon how their health varies. Sessions are kept open for them with this understanding. People also receive support on an ‘outreach’ basis. This enables them to have opportunities at home, or in the community. Sessions which take place at Sarsen House provide a chance to join in for those service users who are too unwell to go elsewhere. When service users have gaps from either of these options, the home’s own staff offer one to one support. There is a strong focus on ensuring that service users participate in their local community. The group have become well known within the village itself. Some friendships have been established with local people. Several service users regularly attend the village church. Individuals also spoke about other regular outings, such as shopping and trips to the local pub. All users have access to a wide range of activities. This is both at home, and outside. At home, people have entertainment equipment in their own rooms, as well as in communal areas. There are also a range of games, puzzles, and books available. Outside the home, users attend some local clubs specifically intended for people with learning disability. They also access a full range of integrated activities. Usually people will go out either individually or in pairs, accompanied by staff. It is clear that this is seen as an important aspect of service delivery. All users receive the opportunity of an annual holiday, escorted by staff. These are done in small groups. Some people may only go for short breaks, if they find it difficult to cope with longer periods of absence from familiar surroundings. Holiday destinations have included trips overseas. Interaction between service users and staff is positive and relaxed. People are able to choose how they spend their time when at home. Staff are knowledgeable about individuals, and sensitive in respecting their wishes. The home operates a no smoking policy. There is generally unrestricted freedom of movement for residents. They are expected to respect the privacy of each person’s own bedroom. Some areas are kept locked for particular health and safety reasons. External access is also made secure. All meals are prepared by staff of the home, in line with the known needs and preferences of the service users. Staff receive training in food safety, and the service has recently obtained some updated information on this topic. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 14 Menus show that a variety of dishes are served. Input and advice has been obtained from a dietician regarding the particular needs of some individuals. Special dietary supplements are used if required. Some people use adapted cutlery and crockery. An occupational therapist has advised on the most suitable items for the relevant residents. Most of the household usually dine together, with staff giving support to service users as necessary. One person’s preference to eat separately is respected. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 15 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): 19 & 20 Service users are supported to address their health care needs effectively. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Health needs continue to develop for the group at Sarsen House. These may be linked to natural ageing processes, or to the particular conditions that people have. There is ongoing monitoring and review of care. As well as responding to situations as they arise, the home plans ahead for likely future changes. This includes ensuring that staff receive training on any relevant topics. As particular individuals have become seriously unwell, additional support has been accessed from all relevant health professionals. Getting input from a range of appropriate sources has been beneficial to both service users, and to the staff team at Sarsen House, by providing skilled assistance, and reassurance that all possible steps are being taken. One service user is to be monitored overnight for a short period, via the use of a web cam, to obtain information about a particular health need. Relevant Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 16 professionals have been involved in drawing up a suitable protocol for this practice, showing that the ethical and legal implications have been taken into account. The observation is being kept to the minimum necessary. None of the present service user group are self-medicating. So staff are involved in storage, administration and recording of any prescribed drugs. They receive training after they have been in post for six months. Arrangements for the management of medication are appropriate. There is secure storage. All required records are maintained accurately. Administration is carried out in line with relevant guidance. One service user has recently been prescribed a new medicine to be given ‘as required’. Although the particular drug is not classified by law as requiring additional controls, it is recommended that some extra measures are applied in its management. Advice on these recommendations has been provided to the home since the inspection. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 17 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): These standards were not inspected on this occasion. The key standards in this section were met at the previous inspection. EVIDENCE: Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30 Service users live in a comfortable environment, suitable to their needs. Most areas are clean and safe, but attention is needed to the utility room to remove risks to the health and welfare of service users. EVIDENCE: All parts of the home were seen during this inspection. Sarsen House is an attractive property, set in its own garden, in a pleasant village location. Accommodation for service users is provided on two floors. This includes a ground floor extension that was added by Tullyboy Homes. The home presents as well decorated and maintained. Periodic audits of the building are carried out. These identify any tasks to be addressed. Over the past year various works have been carried out. For instance, the property has been completely rewired. New oil tanks have also been installed. Some areas of paintwork have been renewed. Most major work is carried out whilst service users are away on holiday. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 19 Each service user has their own bedroom. Four of these are on the ground floor. All rooms are decorated and furnished to reflect the taste of their occupant. Two of the bedrooms have en-suite facilities. The others have bathroom and toilet facilities nearby. Areas of communal space are all on the ground floor. There is a large lounge, and a separate dining room. The kitchen also has a seating area, which is often used by one of the home’s residents. Externally there is an enclosed garden. Records are kept of cleaning schedules, and audited as part of the overall quality assurance process. Care staff carry out all cleaning and household tasks. The approach has recently been reviewed so that more of these are carried out during the week, leaving weekends more free to undertake activities with service users. Also at weekends a couple of young people work a few hours solely on cleaning duties. Laundry facilities are situated in the garage, away from those parts of the accommodation regularly accessed by service users. The flooring underneath the washing machine is wet and unclean. The wall adjacent to this appliance is also damp, with a patch of mould, and the plaster crumbles when touched. The condition of these areas means that satisfactory standards of cleanliness and hygiene cannot presently be maintained, leading to an infection control risk. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 Service users are supported by suitable numbers of staff. EVIDENCE: As a service registered under previous care home legislation, Sarsen House must maintain minimum staffing levels in line with those in place as of 31st March 2002. Staffing requirements are being kept under review, as the needs of service users develop. The home has a minimum of two staff on duty during daytime hours, but aims for three or even four when possible. This is because one service user may need two staff to support their needs at any time. So a third person is required, to attend to the needs of other service users, and be able to escort people away from the home. Managerial staff are usually present during daytime hours, and form part of the numbers providing care. Nights are now covered by a waking staff member, due to the increased support needs of some service users. Three people are employed to work night duty. The home was fully staffed at the time of this inspection. When necessary, cover is maintained by a pool of relief staff. On occasions, agency staff have also been used. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 21 Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 Service users benefit from a well run home, with clear leadership and involvement from senior figures. EVIDENCE: Tullyboy Homes has two registered managers. Both work in both of the homes operated by the organisation. They are each qualified to the required levels in both care and management. In addition, one has a professional background in learning disability nursing. Although not practising in this setting, she has maintained her registration through regularly updating her knowledge. The managers attend a range of courses and conferences. Tullyboy Homes is also a member of organisations concerned with developments in the social care field. Usually these two senior staff will alternate the weeks when they focus on Sarsen House. The other week will be spent in the organisation’s other care home. However, they are available for advice and support when required. The access to two well qualified managerial staff is of advantage to the service. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 23 One carer within the organisation is now studying towards the NVQ Level 4 award, and taking on additional responsibilities. The intention is that this person will also be able to offer managerial support to both services. Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 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 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 4 3 X 4 X X X X X X Sarsen House DS0000028644.V281717.R01.S.doc Version 5.1 Page 25 No 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 YA30 Regulation 13-3 16-2j 23-2d Requirement Utility room wall and floor finishes must be impermeable and readily cleanable. Timescale for action 30/04/06 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 YA20 Good Practice Recommendations There should be additional arrangements for management of a specific drug which may be prescribed for a service user. 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