Inspection on 24/01/06 for Southview

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Southview 10/02/09

Southview 13/09/07

Southview 22/11/06

Southview 22/09/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Southview 34 Yew Tree Close Fair Oak Eastleigh Hampshire SO50 7GP Lead Inspector Isolina Reilly Unannounced Inspection 24th January 2006 09:15 Southview DS0000064107.V270218.R01.S.doc Version 5.0 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 Southview DS0000064107.V270218.R01.S.doc Version 5.0 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. Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Southview Address 34 Yew Tree Close Fair Oak Eastleigh Hampshire SO50 7GP 02380601805 02380695473 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) Milbury Care Services Ltd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd September 2005 Brief Description of the Service: Southview provides care for up to six young adults with learning disabilities and associated behaviour support needs. The home is owned and run by Milbury Care Services Limited a national organisation that employs a manager for the home. This service was first registered on 26th August 2005. The home is located near the centre of Fair Oak within easy access of local shops, other amenities and is on a main bus route and the service users have access to a house car. The building is a two-storey domestic detached house, comprising of six single bedrooms with individual en-suite facilities. The home’s communal space comprises of two lounges, a separate dining room and kitchen/diner. The garden is landscaped with a small area of decking and there is ample parking at the front of the house. Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second unannounced inspection took place over one day. The inspector looked around the home, view records, procedures, spoke with service users, staff, a visiting community nurse and observed the interaction between them. The deputy manager helped the inspector during the visit. Southview has been open for six months now and the service is going well. This and the previous inspection report of 22nd September 2005 can be read together for a full summary of how the home has done against the key National Minimum Standards. What the service does well: What has improved since the last inspection? What they could do better: The local council health and Safety office visited the home in November 2005 and asked for risk assessment records and documentation to be improved. However this has yet to be done. Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 6 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. Southview DS0000064107.V270218.R01.S.doc Version 5.0 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 Southview DS0000064107.V270218.R01.S.doc Version 5.0 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): The above key standards were assessed and met at the previous inspection on the 22nd September 2005. EVIDENCE: Southview DS0000064107.V270218.R01.S.doc Version 5.0 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): The above key standards were assessed and met at the previous inspection on the 22nd September 2005. EVIDENCE: Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 10 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): The above key standards were assessed and met at the previous inspection on the 22nd September 2005. EVIDENCE: Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 11 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): The administrations of medication records were satisfactory. Key standards eighteen and nineteen were assessed and met at the previous inspection on the 22nd September 2005. EVIDENCE: The inspector assessed the records for administrating medication within the home and found all entries had the appropriate signatures or codes detailing reason why the medicine had not been admitted. This was an issue identified at the previous inspection that has been met. Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 12 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): 22 and 23 The home has a satisfactory complaints procedure that service users are able to use and staff have a good understanding of Adult Protection issues that protects residents from abuse. EVIDENCE: The service users spoken with feel they are well looked after and respected by staff that are helpful and nice. They also feel safe, looked after and comfortable. One service user was getting ready to go horse ridding on the afternoon of the visit. A second service user expressed a wish to try horse ridding and a member of staff stated that it would be looked into. The home has been kept clean and tidy. The staff feel the home has helped service users to try new activities and continue to doing things they like. The deputy also confirmed that they have been concentrated on finding activities for the service users to participate in. The home’s complaint procedure includes the address for the Commission and that all complaints will be dealt within fourteen days. A copy of the complaint procedure is available within the individual copies of the home’s service user guide made easy to understand by use of pictures and plain English. The staff are also aware of the homes procedure and the policy and procedure seen was found to be satisfactory. However, the complaint procedure has yet to be made available to visitors at the home. This was discussed with the deputy who had several suggestions on how this may be achieved. The home has received one complaint since opening that has been resolved. A complaint log is available and the organisation has a system for auditing complaints received at the home. The deputy confirmed that detailed records of the complaint is stored separately. Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 13 The staff spoken with confirmed that they have received instruction and are aware of the protection of vulnerable adults from abuse. They have attended training on recognising and reporting of concerns or suspicions. There has been no allegation of abuse at this home. The home has attempted to secure a copy of the latest copy of the Hampshire County Council ‘Protection of Vulnerable Adults’ policy and procedure but has had problems downloading a copy from the internet so has ordered a hard copy from Hampshire County Council. It’s own policy and procedures reflecting the guidelines from Hampshire County council own policy. Southview DS0000064107.V270218.R01.S.doc Version 5.0 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): 24 The home looks homely, comfortable and a suitable environment for the service users. The standard of the décor within the home remains high. Key standard thirty was assessed and met at the previous inspection on the 22nd September 2005. EVIDENCE: The service users stated that the home is warm and comfortable and the inspector observed this. The service users like the home and all were very happy with their rooms. The inspector partially looked around the home and viewed some of the bedrooms and found them to be very individualised. Southview DS0000064107.V270218.R01.S.doc Version 5.0 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 and 34 The staff morale is good resulting in an enthusiastic workforce that is building on good team spirit with staff working together in the best interest of the residents. The home has good practices and procedures for the recruitment of staff that ensure the service users at not put at risk. The home successfully supports staff to undertake appropriate qualifications within care and other training that is relevant to this client group ensuring residents are not put at risk. Key standard thirty-five was assessed and met at the previous inspection on the 22nd September 2005. EVIDENCE: The deputy confirmed that she was the only carer at present who has a National Vocational Qualification (NVQ) level 3 in care. However, the other eight carers employed by the home are in the process of completing their Foundation course in Learning Disabilities Awareness Framework (LDAF). The staff spoken with confirmed this. The deputy manager explained that the carers are planning to start their NVQ level 2 independent living and one carer has expressed an interest in doing their NVQ level 3. The inspector was able to sample three staff training records that evidenced this. The staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to sample three staff records and found that Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 16 they were detailed with the appropriate checks having been taken to ensure staff are fit to work at the home. Southview DS0000064107.V270218.R01.S.doc Version 5.0 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 and 42 The home is well run with an experienced, supportive manager and good organisational structure. The home has a good monthly quality assurance and monitoring systems with service users being fully involved in the process. It is not due to start the first annual audit until August 2006 when the service has been open for a full year. The service users’ health, safety and welfare are appropriately promoted by the home to ensure everyone is protected. EVIDENCE: The manager undertakes regular update training and holds a National Vocational Qualification Registered Manager’s Award. However, has yet to apply for registration with the commission as she is currently undertaking a dual role as organisation operations manager role as well as manager for the home. The organisation is looking to employ a Permanent full time manager for the home and the deputy manager stated that the adverts for the post are due out in February 2006. Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 18 The staff spoken with confirmed that there is a clear line of authority within the home. They also felt that since the manager Mrs Sherilee Davis has been in post there has been a big improvement in the structure and support at the home. This has increased the confidence of the staff and enabled them to develop within their roles. The other staff spoken with confirmed this stating that the home is now settled and a very happy atmosphere for the service users and staff. The service users spoken with stated that the manager is nice. There are four Milbury Care Homes currently in Hampshire and the managers’ meet regularly providing a support network for each other. The agency is regularly internally audited by the organisation and undertakes monthly monitoring visits. The commission has received regular written reports under the Care Homes Regulations, regulation 26. The home has yet to undergo a full formal annual audit as it has only been trading for six months. The inspector observed the service users being appropriately consulted (verbally) by staff on their opinions for activities for the day and further events planning. There are four Milbury Care Homes currently in Hampshire and the managers’ meet regularly providing a support network for each other. The home has comprehensive policies and procedures that are developed by the organisation and implemented by the home’s manager. These are reviewed regularly and staff sign that they have read them. Amendments to policies and procedures are discussed at staffs meeting that are minuted. The inspector noted that the local council health and safety officer had visited the home 9th September 2005 and identified four areas where the home’s policies, procedures and risk assessments needs to be up dated so that they comply with the Health and Safety Act 1974. The inspector and deputy were unable to find the amended risk assessment documents. The deputy tried to contact the organisation’s area health and safety officer but he was unavailable. The deputy manager confirmed by phone following the inspection that the health and safety amendments had been completed and the file is available in the home. She assured the inspector that the organisation’s area health and safety officer had completed the up dating requested by the local council health and safety officer. The service users stated that they like the home and feel safe. The staff have all undertaken regular training and refresher up dating in first aid, fire safety, food hygiene, health and safety, Control of Substances Hazardous to Health, infection control and moving and handling. The staff spoken with confirmed this. The inspector sampled random copies of training certificates and records of dates training has been undertaking. On the tour of the home it was noted that cleaning chemicals are stored appropriately. The home’s has information sheets for the Control of Substances Hazardous to Health (COSHH). Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 19 The home’s maintenance records were seen by the inspector and found to be satisfactory. The home has a system of testing the fire alarm weekly. The inspector was able to view records that confirmed that the home has tested the fire alarm, undertaken visual checks of fire extinguishers, emergency lighting and smoke alarms. There were also recent maintenance certificates for all fire safety equipment within the home. The home has a system of testing the fire alarm weekly. All the service users state that the staff do set off the alarm to ensure that it is working. They also said that sometimes the alarm goes off and everyone has to go outside, although there is no fire. The staff explained that the evacuation undertaken by the home include the service users. The inspector was able to view records that confirmed that the home has tested the fire alarm, undertaken visual checks of fire extinguishers, emergency lighting and smoke alarms. There were also recent maintenance certificates for all fire safety equipment within the home. Southview DS0000064107.V270218.R01.S.doc Version 5.0 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 X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X x LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Southview Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000064107.V270218.R01.S.doc Version 5.0 Page 21 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. 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. Refer to Standard Good Practice Recommendations Southview DS0000064107.V270218.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hampshire Office 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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