Inspection on 09/03/06 for Seabrook House

This inspection was carried out on 9th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seabrook House 20/12/06

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

CARE HOME ADULTS 18-65 Seabrook House Seabrook House Topsham Road Exeter Devon EX2 7DR Lead Inspector Stephen Spratling Unannounced Inspection 9th March 2006 11:30 Seabrook House DS0000066051.V277938.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 Seabrook House DS0000066051.V277938.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. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Seabrook House Address Seabrook House Topsham Road Exeter Devon EX2 7DR 01392 873995 01392 877177 seabrookhouse@tiscali.co.uk www.ukhcg.com Seabrook House Limited 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) Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (26) of places Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The provider is required to appoint a manager to be in day to day charge of the home, who must submit an application to the CSCI to register to become the registered manager of Seabrook Care Home by 28 March 2006 16th May 2005 Date of last inspection Brief Description of the Service: Seabrook house is Registered to provide personal care for up to 26 people who have or have had mental health problems. It is situated on the main road, a regular bus route, from Exeter to Topsham, about ½ mile from the centre of Topsham. Seabrook consists of two separate buildings. One is a large detached converted property with a recently added extension; this building has a variety of accommodation and a ‘training kitchen’. The other building, occupied by more residents, has two lounge areas and a kitchen for residents to use. All the bedrooms are single occupancy and some have ensuite shower and toilet facilities. The home has a large level garden which residents use and help to maintain if they wish. Staff are available in the home 24 hours a day. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was started on 9th March 2006 when the inspector visited the home unannounced and was concluded 15th March 2006 at a time agreed with the manager. On the day of the inspection the inspector spoke with nine of the 25 people living at the home. He also spoke with the manager, the company regional manager and five of the care staff. Additionally he looked at some of the policies and other records kept by the home. A limited number of the National Minimum Standards were looked at during this inspection and for a fuller picture of this service the reader is advised to also see the last inspection report of 16th May 2005. Seabrook House changed ownership about six weeks before the date of this inspection. The new owners have begun to introduce many positive changes to the way the home is run including; providing more administration support to the manager, increasing staff rates of pay and increasing staffing levels. What the service does well: What has improved since the last inspection? What they could do better: All checks on new care staff must be done before they start working in the home. Staff need more training and much more detailed plans of care need to be developed and followed so that the needs, potential and personal goals of each Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 6 individual person living at the home can be worked towards. More help should be given to residents to help them be more independent with their medication and to support them to develop relationships with people from outside the home. 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. Seabrook House DS0000066051.V277938.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 Seabrook House DS0000066051.V277938.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): 2 Residents can be confident that all their needs will be recognised at the time they are admitted to the home. EVIDENCE: The inspector looked at the assessment information collected about three residents. All contained a collection of information from different sources including Care Program Approach assessments and care plans; these identified the needs of individuals at the point of admission. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 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&9 Residents can not be confident that all their needs will be met nor that staff will know how best to work to keep them safe due to inadequate care planning and risk assessment practices. EVIDENCE: The care plans for three residents were looked at. None of them fully reflected the resident’s needs identified in the assessments. For example one resident who’s assessment said they had a history of self harm and who staff told the inspector had expressed suicidal ideas had no care plan to guide staff what to look out for as signs that this person may be thinking of self harming nor how they should respond if they are concerned about them. Another resident whose assessments indicated they had chronic physical health problem, did not have an adequate care plan to describe how staff should help them to stay well or what they should do if this person were to become acutely unwell. The new regional manager said that she had already identified this deficit and was planning to implement a new care planning system. Most residents asked said they are consulted about their care plans and given a copy if they wish. Care pans did show evidence of review. Care staff said that they as Key workers complete care plans with residents. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 10 All three residents records looked at contained risk assessments covering issues such as self-harm and vulnerability to abuse. Some did not appear to have been reviewed for some time where a raised risk had been noted, for example one indicated that a resident was at risk of self-harm/suicide but this had not been reviewed since April 2004. Where risk assessments indicated that residents were at a moderate or high risk of harm from a behaviour or activity this was not reflected in care plans. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 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): 15 Residents cannot be confidant that they will receive the help and support they need to form and maintain healthy fulfilling relationships. EVIDENCE: The manager said that the policy regarding sexual relationships is under review, but that residents would be supported to conduct relationships. Staff said they did not know of any of the 25 residents currently having intimate relationships. Residents spoken with confirmed they feel free to spend time with whom and where they wish. Care records seen did not reflect service users aspirations or concerns regarding developing and maintaining meaningful relationships. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 12 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): 20 Residents can be confident that medications are handled safely, though more should be done to ensure residents willing and able to manage their own medication are helped to do so. EVIDENCE: One of the care staff showed the inspector the homes medication management system. All medications are securely stored, with record of receipt and administration being done properly. The medications fridge is secure and temperatures appropriately monitored. The staff member said that none of the current 25 residents manage their own medication. The manager told the inspector that a risk assessment is conducted for residents who wish to handle their own medication and secure storage would be provided in their rooms. She told the inspector that one resident is working towards managing their medication themselves having agreed that staff will not prompt them when medication is due. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 13 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): 23 Residents can be confident that staff and managers would act properly to protect them if they were being mistreated/abused. EVIDENCE: The manager said that four members of staff have done Protection of Vulnerable Adults Training with Devon Social Services in the past year. The homes policy regarding recognition and reporting of abuse has been updated, it was read by the inspector and provides clear and appropriate guidance for staff. Two staff asked about what they should do if they were concerned that a resident was being abused were clear about their responsibilities to report. Residents indicated confidence that staff and managers are approachable and act if they have concerns. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 14 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): None of these standards were assessed during this inspection. EVIDENCE: On taking over the home the new owners agreed to carry out a number of environmental improvements. Through this inspection it was evident that work has started. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 15 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): 32, 34 & 35 Resident’s benefit from being cared for by kind supportive staff. However they cannot be confident that all staff have yet received the training they need to ensure they have knowledge and skills to care for them in the best way possible. Recruitment procedures are not sufficiently robust to protect residents from people who may not be suitable to work for them. EVIDENCE: Considerable work has been done to develop a training needs assessment for all staff. Seen by the inspector it identifies what training care staff have done and what they need to do. To complement this a training schedule for the coming year has also been developed. Staff confirmed that they are now paid to attend training and that more training is being made available. The manager said seven staff have done NVQs and five are about to start. A member of staff in post 6 months said they had done fire training but nothing else since starting in post and said they did not have a structured induction. Another new member of staff (appointed under the previous owners) also said they had not had a structured induction when first working at the home but was very positive about planned training, indicating they had something booked for each month for several months ahead. A member of staff in post about 18 months said they had done training about managing challenging behaviour and medication and that they were to do a study day on Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 16 Mental Health awareness the day following the inspection. On the second day of the inspection the inspector was shown certificates that indicated almost all staff had just done a study day on mental health awareness. Residents described staff in very positive terms; one resident said that during a recent difficult period staff had been very supportive and kept a close eye on them. All residents spoken with said they liked the staff and feel supported by them. The recruitment files for three care staff were looked at; none contained all the required pre-employment checks. One was missing copies of identification and one had only one reference though two had been requested the second had not been followed up. The third of a staff member on induction did not have a Criminal Records bureau Check (there was evidence that it had been applied for) nor a Protection of vulnerable adults 1st check, one of the two references was a verbal reference and copies of this persons identification had not been taken; the manager assured the inspector that this person was on induction and working under supervision but did agree that this person should not be working until all required checks had been satisfactorily received. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 17 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 Residents can be confident that the implementation of a more systematic approach to running and to monitoring the quality of the service, are helping to maintain and improve the standard of the service they receive. EVIDENCE: The current manager has many years experience of caring for people with mental health difficulties (an application for her to Registered by the commission is currently being processed); she is now supported by a recently appointed administrator and the new companies Regional Manager. Residents and staff say that managers are approachable and listen to their concerns. One staff member said of the management that you now “just ask and its done”. One of the residents commented that they feel the “atmosphere in the home has improved” in recent weeks. The inspector was shown many new systems that are being implemented to help develop the service. Amongst these is a comprehensive quality assurance system, which includes regular audits of all key areas, including the environment and staff training. Questionnaires about the service, which will also be sent to residents and other stakeholders on a regular basis. The regional manager said an annual quality report and annual Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 18 development plan will be developed and published using the quality assurance information collected. Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 19 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 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 X X 2 x LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 2 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 x 3 X 3 X X X X Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 20 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 YA6 Regulation 15 Requirement …the registered person must…prepare a written plan (care plan) as to how the service users needs in respect of his health and welfare are to be met. The registered person must not employ a person to work in the care home unless he has obtained in respect of that person all the information and documents specified in schedule 2 of these regulations. Timescale for action 09/06/06 2 YA34 19 09/04/06 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 YA6 Good Practice Recommendations Service users care plans should set out how the service should help a service user to meet their goals and aspiration; how current and anticipated specialist DS0000066051.V277938.R01.S.doc Version 5.1 Page 21 Seabrook House requirements will be met and should establish procedures for responding to and caring for service users who are likely to be aggressive or cause harm to themselves, focusing on positive behaviour, ability and willingness. 2 YA9 Risk assessments should be conducted, kept up to date and strategies should be developed to helped minimise and manage risk whilst maximising residents capacity for independence. Service users should be supported to develop and maintain intimate personal relationships with people of their choice, and information and specialist guidance should be provided to help the service user to make appropriate decisions. The registered manager and staff should encourage and support service users to retain, administer and control their own medication… 50 of care staff in the care home should achieve NVQ2 and should be trained to develop skills specific to needs of the service user group. e.g. rehabilitation and recovery techniques for people with mental health problems. All staff should receive structured induction training (within six weeks of appointment) and foundation training (within six months) to sector skills council specifications. 3 YA15 4 YA20 5 YA32 6 YA35 Seabrook House DS0000066051.V277938.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. 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