CARE HOME ADULTS 18-65
Saxon House 8 Saxon Close Warsash Southampton SO31 9TS Lead Inspector
Wendy Thomas Unnannounced 14.07.05 15:00 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. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Saxon House Address 8 Saxon Close Warsash Southampton Hampshire SO31 9TS 01489 601351 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) Mr Alan Green Mr Alan Green Care Home 2 Category(ies) of Learning Disability - LD - 2 registration, with number of places Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10.02.05 Brief Description of the Service: Saxon House provides accommodation to two gentlemen with mild to moderate learning disabilities. There is a strong family emphasis as the gentlemen live with the proprietor, his mother and his daughter. No additional staff are employed at the home. The men are included in every day activities and are fully integrated into the family. The home is situated in a small cul de sac in Warsash, and is within easy reach of the village of Warsash, Park Gate, and on a regular bus route to Fareham town centre Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. During the inspection the inspector talked with both clients, one alone and one with the registered person, and with Mr. Green the registered person and carer for the two clients. Mr. Green’s mother and daughter also live at the home and they were at home at the time of the inspection. The inspection lasted 3.75 hours. The people in the home requested to be known as clients, so this term is used throughout the report. What the service does well: What has improved since the last inspection?
Clients risk assessments had been rewritten and related more closely to the situation in the home. Written records completed by one of the clients for a period of several weeks showed that the clients were getting opportunities to participate in activities outside the home with Mr. Green or friends of the household. The client had done a good job in producing comprehensive records. Mrs. Green has done food hygiene training. The clients and Mr. Green had been in contact with the clients’ GP to discuss their medication following a request from the inspector in the previous inspection.
Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 6 A laundry procedure has now been produced. 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. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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 standard(s) 1 Completing the service user’s guide and statement of purpose will provide the clients with information regarding what they can expect from the home. EVIDENCE: The service user’s guide, statement of purpose and terms and conditions of residence/contract were seen. Although the contract had been reissued since the last inspection it still referred to a licensee agreement that was not yet in place. No further work had been done to the statement of purpose and service user’s guide since the last inspection when a requirement was made that it be completed. This was discussed and it was agreed that given the family style nature and size of the home three separate documents were not necessary, but there could be one document containing all the information requested in the Care Homes Regulations 2001 and National Minimum Standards. Mr. Green agreed to add the additional information and compile a comprehensive document for the two current clients. Mr. Green does not intend to provide a service for anyone other than the two current service clients. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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 standard(s) 6, 7, and 9. Individual plans identify client’s goals. Progress towards achieving these would be enhanced by plans and monitoring. Clients are involved in decision-making regarding themselves individually and the household. Clients benefit from having areas of risk identified, and the level of risk assessed and reduced where appropriate. EVIDENCE: Despite discussion at the previous inspection and a recommendation in the report that more appropriate assessments be used, clients’ files still contained assessments of a predominately medical nature that were not pertinent to their needs, such as Bartel activities of daily living index, moving and handling assessment and details concerning continence and ability to feed themselves. Mr. Green agreed to research more appropriate assessment formats. Clients’ files identified goals that they had chosen to work towards. These were dated March 2005 but the client asked said that he had not begun pursuing one of these, to use the computer, although he did sometimes go to McDonald’s, which was another of his goals.
Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 10 Risk assessments had been reviewed in March 2005, and following a recommendation in the previous inspection report, they were more realistic in reflecting the situation in the home and were more relevant to the clients and the lives they lead. The clients were clear that they were responsible for their own decisions. One client described how Mr. Green supported him when he felt that people outside the home did not respect his wishes, and the decisions he made for himself. Both clients said that they were fully involved in decision making within the home. There was some discussion between the inspector, Mr. Green and one of the clients regarding decision-making and duty of care. The clients stated on several occasions that they were very happy in the home and satisfied with their level of activity. They did not want to develop new skills or try out new experiences. They were happy spending almost all of their time in the home with the occasional excursions to the shops, post office or car boot sales. They had lived in the home now for a number of years and were settled and happy in their routines. Neither have any wish to move from the home, except to move as a household to Spain, which is a hope shared by all at Saxon House. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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 standard(s) 12, 13, 15, and 16. Clients would benefit from more opportunities for personal development, educational activities, community involvement and participation in household chores. However, they assert that they do not wish to increase these. The clients’ friendships and relationships are limited to the friends and relations of the other members of the household. EVIDENCE: The clients take part in limited range of activities within and outside of the house. Both are very clear that they are happy with this and do not wish to extend the range or frequency of their activities. There are a number of friends of the household who visit and sometimes one of the clients goes out with them. Other members of Mr. Green’s family were also reported to have close links with the household. One of the clients has a keen interest in music and enjoys spending much of his time listening to music. He also told the inspector that he enjoys watching
Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 12 certain programmes on television. The other client described running errands to the local shops, but said that on the whole he preferred to spend his time around the house. He described activities he used to be involved in in the past such as attending day services and going to the pub, but said that he had got bored with this and was happy with his life as it was now. Mr. Green said that he continued to offer activities and opportunities to the service users but most were declined. Domestic chores are carried out by Mr. Green and his mother, who also cooks for the household. The clients choose to have minimal involvement in this. Mr. Green will not keep records about the activities and opportunities that the clients are offered or take part in as they have asked him not to. This was discussed prior to the last inspection and one of the clients had volunteered to keep these records. He had now stopped doing this but showed the inspector those he had kept. They contained more than enough information for the inspector to form a judgement as to the clients’ level of activity and showed that one of the clients had participated in activities outside of the home with members of the wider support network on several occasions. Ways to simplify the recoding so that it would take up less time were discussed, and the client agreed to resume record keeping. Mr. Green had commissioned a report from a private psychiatrist in which it was suggested that the clients were making informed decisions about their activity levels and that they were appropriate to their needs and abilities. At the previous inspection one of the clients had decided to keep records of the meals provided. This was not happening so the inspector was unable to form a judgement about the food provided. Clients described buying clothes from charity shops. One said that he would sometimes go into town for new clothes, but didn’t need any often. Sometimes Mr. Green or his mother purchase clothes on clients’ behalf. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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 standard(s) 18, and 20 Clients received personal care support proportionate to their needs. Clients’ well-being is promoted through the home’s medication procedure, however increased understanding about the medication and any side effects would enable Mr. Green to monitor and assess risks more effectively. EVIDENCE: Both clients informed the inspector that they did not need help with their personal care needs. Mr. Green agreed, saying that prompts were offered where necessary. Following the inspector’s concerns in previous inspection reports that clients had been taking medication for a long time without it being reviewed, Mr. Green had arranged for their medication to be reviewed on 19 May 2005. The GP had said that there was no need to do this and that both people’s medication should remain unchanged. The client spoken with about medication was happy with the support he received. The previous inspection report had contained a requirement that Mr. Green obtain information about clients’ medication, the conditions it is used to treat,
Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 14 its effects and side effects. He reported that he had obtained a copy of the BNF. When asked about the specific medications that the clients were taking he explained that he had asked the clients’ GP in the past but could not now recall the details. Mr Green is advised to find out this information and record it in the clients medication or medical records. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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) 22 Clients were confident that they could discuss any concerns or complaints with Mr. Green. EVIDENCE: Clients were asked about complaining and both said that they would discuss any concerns with Mr. Green. Both clients had copies of the complaints procedure in their files. In the past they had kept these files in their own rooms but they were currently being kept in Mr. Green’s room. It was reported that they knew where they were and could access them at any time. One client said that this was better as he feared he would lose his amongst his other belongings. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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 and 30 Clients benefit from a homely environment with comfortable domestic furnishings, which is kept clean and has a good standard of hygiene. EVIDENCE: The inspector did not tour the whole building but the lounge, dining room and downstairs toilet were decorated and furnished as any family home. The décor and furnishings were of a good standard and all were in good repair. A new three-piece suite had been purchased for the lounge since the last inspection. The clients explained that Mr. Green had chosen this. Those parts of the house inspected were clean, tidy and hygienic. There were no unpleasant odours. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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) EVIDENCE: No staff are employed in the home with Mr. Green providing the care and his mother acting as housekeeper. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 18 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) 42 Health and safety systems are in place to protect clients from health and safety risks. EVIDENCE: Systems were in place to safeguard all members of the household in relation to health and safety: - The inspector saw notification that the annual safety and maintenance Inspection had been booked for 28 July 2005. Mr. Green reported that the contract covered gas, electricity and plumbing. - A satisfactory fire procedure was seen. - The fire detectors in the house were being tested weekly. - Fire drills were being carried out every two to three months. A laundry procedure had been produced and clearly described appropriate measures for transporting laundry in the kitchen. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 19 As required in the last inspection report Mrs. Green had undertaken food hygiene training. Mr. Green had not undertaken first aid or infection control training as required in the previous report, however he gave a verbal undertaking that he would do this by Christmas 2005. It was explained that cleaning chemicals were housed under the kitchen sink and in the en suite of Mr. Green’s bedroom. Given the nature of the home and clients this was felt to be appropriate, however a risk assessment is needed. Mr. Green said that the electrical wiring had not been checked in the seventeen years since the house was built. Health and safety guidelines recommend that this be done every five years. Mr. Green was advised to obtain a copy of the Health and Safety Executive’s booklet regarding health and safety and related legislation for care homes. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 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. 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 2 x x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Saxon House Score 3 x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 21 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 Regulation Requirement Timescale for action 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. 5. 6. Refer to Standard 1 6 20 42 42 Good Practice Recommendations All the designated information (Care Homes Regualtions 2001 Schedule 1, National Minimum Standrads 1.2 and 5.1) should be compiled and made available to the clients. Individual client plans should monitor how goals are being achieved. It is recommended that Mrt. Green find out more about clients medication, the conditions it is used to treat and any side-effects. A risk assessment is needed relating to the storage of cleaning chemicals. It is advised that the electrical wiring be checked by an appropriately qualified electrician. Saxon House H54 S12180 Saxon House V238594 140705.doc Version 1.40 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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