Inspection on 28/06/07 for Shakespeare House

This inspection was carried out on 28th June 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shakespeare House 09/01/06

Shakespeare House 19/08/05

Shakespeare House 08/09/04

Shakespeare House 13/05/04

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

CARE HOME ADULTS 18-65 Shakespeare House 34 Pier Road Littlehampton West Sussex BN17 5LW Lead Inspector John Vaughan Unannounced Inspection 28th June 2007 09:45 Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shakespeare House Address 34 Pier Road Littlehampton West Sussex BN17 5LW 01903 723164 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Elizabeth Howes Mrs Susan Elizabeth Howes Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users in the MD (mental disorder, past or present) category under 65 years may be admitted to the home. 9th January 2006 Date of last inspection Brief Description of the Service: Shakespeare House is a care home registered to accommodate up to 3 residents in the category of younger adults, with an additional condition that 1 of the residents could be in the category of older persons. It is a three storey terraced property located in Littlehampton, near to the river and the sea. The service is owned and managed by Mrs. Susan Howes. The current week fee to live in this home is £303.00. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector met with people using the service, the staff member and the owner/manager of the home during the visit to the service, which took place over one day. During the visit the inspector spoke to people about their experiences of the home, observed people and staff, sampled records, interviewed staff and looked and the facilities and environment provided for people who live in the home. The inspector also reviewed information held by the commission including previous reports, incident reports, surveys returned by people who live in the home and care managers. The Annual Quality Assurance Assessment (AQAA) provided by the manager of the service was also used in the preparation and planning of this inspection. What the service does well: What has improved since the last inspection? Funding has been secured to install a wet room replacing the current bathroom to make for a more pleasant environment for people. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are only admitted on the basis of an assessment to ensure the home can meet their needs. EVIDENCE: The inspector met with the manager and discussed the admission procedure to the home. He was told that anyone looking to move into the home has the opportunity to visit the service and talk to the manager, people who live in the home and look at the facilities in the service. Each of the files for people living in the home contained information on the needs together with care manager assessments and specialist community team assessments. The manager stated that they keep in contact with care managers and the mental health services for input on peoples needs and a referral has been made for a reassessment of one persons needs. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 9 There have been no permanent admissions to the home for some time and the vacant room is used infrequently for respite. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The size of this service and minimal staffing has meant that an individualised and informal arrangements have been achieved to meet the needs of people however to ensure a consistent and adaptive service the manager will need to improve the care planning and risk assessment procedures. EVIDENCE: The inspector examined the records for the two people who currently live in the home. The folder contains information on the needs of the individuals and the manager completes a monthly summary for each person and a six monthly care plan review. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 11 The six monthly reviews consist of a paragraph of information/observations of the manager and what needs to be focussed on to support the individual. The manager explained that this is the care plan and there are no other documents. The plan has no real structure or clear strategies to demonstrate how support is provided to meet people’s needs. The information did not give a picture of the person’s wishes or aspirations. The manager was very clear on the needs of the two people and she provides support to them on a daily basis with a second person covering for two shifts per week. The inspector spoke to both people living in the home about the support they receive. Both individuals said that they feel very well supported in the home and are able to make decisions about their day-to-day lives, what they want to do and pursue interests and activities that they enjoy. The people using the service said that the manager has daily contact with each person and the practices in the home have created a very close and supportive relationship between the manager and the people she supports. Information in each of the files indicated the need for risk assessments to keep people safe in areas such as fire safety, vulnerability in the community and medication. The inspector could see that the manager had documented concerns and discussed these concerns with other professionals and general practitioners. These areas have not been addressed through a formal risk assessment to document the response or strategy to minimise the risk of injury to the individual. The manager was advised that she must record the actions to be taken of minimise these risks and ensure her staff member understands this approach. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service continue to benefit from a range of activities based on their assessed needs, interests and hobbies together with a balanced and varied menu offering choices and healthy options. EVIDENCE: The inspector met with both people who use the service and he discussed their experiences and views on the home. Both people said that they were very happy and content living in this home. They said that they are encouraged and supported to take part in the local community and have groups of friends that they meet in local clubs and pubs. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 13 One person supports a premiership football team and their room has been decorated to reflect this activity. The individual also goes to see a local team play making use of public transport. Individuals also keep in touch with family members and they told the inspector that there are no restrictions on visitors to the home. The people who use the service told the inspector that they have their own daily routines and activities that they take part in and have control over their own lives. The home is very informal and relaxed and on person stated that the owner can’t do enough for them. The manager provides home cooked food for the people who live in the service and keeps a diary of what has been provided. The inspector was told by both of the people living in the home that they are very happy with the meals and they are provided with food that they like to eat. People choose to eat their meals in their rooms however a lounge/dining room is available for people to use. The manager stated that she meets with each person to plan their menu and is aware of their likes and dislikes. The inspector noted the manager’s attention to detail and individual response to the dietary needs of the people living in the service. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical and emotional needs of service users are well met and improvements to the medication system and storage arrangements keep people using this service safe. Further improvements to risk assessments in the service would enhance the approach the home takes when supporting people with their medication needs. EVIDENCE: The inspector saw evidence of contact with General Practitioners, dentists and specialist consultants and a record is maintained of contact with health professionals. Details of health and emotional support needs are included within the individual’s file. One person has recently been supported to undergo major surgery and has now returned to the home. The person is very complimentary of the treatment Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 15 he received in hospital and the continued support they receive from the manager. A monitored dosage system is being used and medication is stored in a secure cabinet. This has been introduced since the last inspection. Medication records were accurate and the inspector noted a recent inspection by the community pharmacist and recommendations were made of which most have been met. None of the service user’s currently self administer medication however from talking to the manager and reading the report from the pharmacist there are issues with the supervision of one person with medication. The inspector saw evidence that the manager is discussing the concerns with the person’s general practitioner and the practices the manager follows supports the individual to make a choice however a documented strategy is required to show how they are keeping the person safe from the risk of overdosing. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home can demonstrate that the views and concerns of service users, their families and representatives are documented and acted upon. The practices within the home mean that service users are protected from abuse. EVIDENCE: The inspector saw evidence to confirm that the home has a policy a procedure for responding to complaints. The manager also has a copy of the multi agency strategy for protecting vulnerable adults. Both people living in the home told the inspector that they feel safe and are confident that if they were concerned about anything that the manager would support them. The inspector was told that they both had copies of the complaints procedure. Information seen on one person’s file demonstrated that when the manager has been concerned about the safety and well-being of this individual that they have reported their concerns and worked with other agencies to keep the person safe. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 17 The manager supports both people to manage their finances. Bank records and receipts are maintained for financial transactions. Both people manage their personal allowances and told the inspector that they have secure storage facilities in their rooms to keep valuables and money. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service benefit from a well maintained and comfortable home enhanced by individually personalised private rooms. EVIDENCE: The inspector looked at the facilities and fixtures in the home and observed that it was clean, tidy and free from any unpleasant smells. Two people allowed the inspector to view their private rooms. These rooms were decorated to their personal tastes with pictures, posters and personal items. Both people said that they were very pleased with their rooms and had everything that they need. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 19 The home has a communal lounge/dining room that is decorated and furnished to a good standard and one person said that they enjoy sitting in this room. A stair lift has been installed to help access to the lounge for people who have restricted mobility and the manager has secured funding to install a wet room to replace the current bathroom. The work will be completed as soon as the manager has secured the contractors to carry out the work. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service are supported by enthusiastic and experienced staff however improvements to the training provision is required to meet the needs of the service. EVIDENCE: The inspector note from information provided by the manager prior to the visit to the service that they only employ one member of staff to cover the times that they are away from the home which is usually two shifts a week. This level of staffing is in keeping with the current needs of the people who live in the home. No new staff have been recruited in four years. The member of staff spoke to the inspector and said that they feel very well supported by the manager and are experienced in working in the care field. The manager provided written evidence of weekly meetings as a staff team and supervision sessions. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 21 Both people using the service are very happy with the support they receive and the inspector noted how comfortable and relaxed people were around the manager and member of staff. The manager does not have a training programme for their member of staff. This was discussed and the manager recognised the need to improve training but stated that it was a financial restriction. The inspector could see no evidence that the staff member had undertaken any training in mandatory areas such as health and safety, food hygiene, fire safety, first aid or adult protection. The manager stated that they discuss these topics and any concerns the member of staff has she will address. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is managed in an informal and open manner however some improvements are required to health and safety arrangements in the home. A system is in place to develop the service with views from service users. EVIDENCE: The manager Mrs Howes also owns the service and took over the business in 2002. the inspector was informed that Mrs Howes has completed her Registered Managers Award (RMA) and is now waiting for the verification of her work. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 23 The service is very informal and both the staff member and two people who use the service spoke very positively about the manager and how they are supported to live their lives. Regular meetings take place to share information and the manager works directly with the people who live in the home. Every three months the manager asks people who use the service to complete a survey. Evidence of regular maintenance of the homes heating and hot water systems was seen however the record of fire alarm system servicing could not be found for this year and the manager agreed to chase this up. The inspector also noted that the manager does not check her fire alarm system on a weekly basis. A three monthly check is carried out and when the manager described how she checks the smoke detectors with a candle the inspector advised that she speak to the Fire Safety Officer for up do date advice on the correct method and frequency for checking these devises. Evidence of fire training for staff or the manager could not be seen. The manager stated that the fire crew who visit the service to inspect the safety arrangements usually provides this. The records indicated that the last visit was December 2005 and therefore staff have had no training in two years. Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 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 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 3 X Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 People who use this service must have a care plan to demonstrate how their needs are to be met. People who use this service must have risk assessments to keep them safe from abuse in the community, fire safety and overdosing. Staff members must have training to meet the needs of the service and people who use this service. Fire safety training must be provided for the manager and staff member at regular intervals in accordance with the advice from the Fire and Rescue service. Timescale for action 06/09/07 2 YA9 13 02/08/07 3 YA35 18 (1)(c) 06/08/07 4 YA42 23(4)(d) 02/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 26 Shakespeare House DS0000014712.V339913.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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