Inspection on 08/07/05 for Summerlands

This inspection was carried out on 8th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Summerlands 17/07/08

Summerlands 20/07/07

Summerlands 29/06/06

Summerlands 01/02/06

Summerlands 06/01/05

Summerlands 12/07/04

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

CARE HOME ADULTS 18-65 Summerlands 9 Villiers Road Southsea PO5 2HG Lead Inspector Ian Craig Unannounced 8 July 2005 9:30 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. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Summerlands Address 9 Villiers Road, Southsea, PO5 2HG 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) 023 9283 0682 Mrs Francesca Bilsland Miss Joy Tremayne Care Home 23 Category(ies) of Learning disability (23) registration, with number of places Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users in the category LD must be at least 40 years of age. One current, named, service user over 65 years of age can be accommodated. One current, named, service user in the category MD can be accommodated. Date of last inspection 6/1/05 Brief Description of the Service: Summerlands is a Grade 2 listed building designed by the architect Thomas Owen and built in the 19th century. The interior and exterior of the home have numerous features of architectural interest. It has been converted to provide accommodation for 23 service users who have a learning disability. The home is close to Southsea shopping centre as well as the sea front, promenade and beach. The service is set over four floors and has five single rooms and nine doubles. There is a stairlift between two floors, but as this does not extend to the floor with the sitting room and dining room, the service could not be said to be suitable for people with mobility needs. The service is privately owned by Mrs F Bilsland. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Assistance was given throughout the inspection by the manager, Miss Joy Tremayne. Six service users were interviewed during the inspection and several more were spoken to. The inspectors also spent time talking two staff members. What the service does well: What has improved since the last inspection? What they could do better: Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 6 Improvements are needed in how the home administers medication to residents. As previously stated, the maintenance and refurbishment plan has not been followed and areas of the home need to be given priority for improvement. Staffing levels were found to be approximately 50 hours less than at the last inspection. The previous inspection report required that staffing levels are increased so that residents’ needs can be met. 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. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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 Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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) 2 The home liaises with social services and day services to review resident’s needs on a regular basis. Individual needs are also assessed and reviewed by the home to ensure that needs, preferences and wishes are addressed. EVIDENCE: Residents were able to describe how they are involved in devising their care plan with their keyworker. All those residents spoken to about their care plans stated that they felt their needs were being met. Records include copies of the home’s own reviews of needs as well as reviews with social services’ care managers and day services where applicable. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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 and 9 Written care plans and risk assessments are of a high standard and residents confirmed their involvement in compiling their own plan. EVIDENCE: Since the last inspection, the manager has devised a new pro forma for the care plans and risk assessments. Both the structure and content of these documents are of a high standard. Each resident has a care plan detailing personal care needs, daily routines, day care, leisure, preferences etc. For one resident care plans detailed the preferred activity of going to Cosham station by train. The resident confirmed that he has had travelled to Cosham by train accompanied by his keyworker. Records include daily running entries as well as details of ‘keyworker’ sessions with individuals. Three residents confirmed their involvement in the care planning process with their respective keyworker. Each of the care plans and risk assessments seen were signed by the resident. Risk assessments are also of a high standard, detailing specific activities where risk has been identified and the action staff should take. These include use of public transport, road safety, financial management, safety in the kitchen, mobility and personal hygiene as well as any other needs such as behaviour. Specific risk assessments had been completed for neurological conditions. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 10 Residents confirmed that they access the local community and others stated that they only go out with staff support. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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) 11, 12, 13, 14, 15, 16 and 17 The home promotes residents having a full life by providing and facilitating activities on a daily basis including opportunities for personal development, education, employment and leisure. Residents are able to have a holiday and have a choice about the activities they attend. The provision of extra staffing would permit residents to have further opportunities for activities and personal development. Residents have links with family and friends. Choice and variety are provided in the provision of meals. EVIDENCE: Individual care plans have been developed to show how each person’s needs are assessed and what the arrangements are for personal development, leisure, education, occupation and other social activities. Residents have the chance to develop personal living skills mainly via day service programmes. Residents attend educational and occupational activities at schemes outside the home. These include literacy classes, computing, basketwork, cookery, music, arts and crafts. These are recorded in the Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 12 individual care plans and residents were able to confirm attendance at these activities. Residents benefit from involvement in local community groups, including those specialising in ethnic minority needs. Several residents visit local facilities, such as shops either escorted by staff or alone. Residents also attend local church groups, charitable organisations and private providers who offer social support for people with learning disabilities. Again, residents were able to confirm that they make use of local facilities, including cafes and shops as well as seafront entertainment in the summer. Residents have a wide range of leisure activities. These include holidays with family as well as independent holiday camp breaks. One resident visits a local pub independently. There are a number of clubs and facilities for service users to attend where entertainment takes place. The inspector was able to observe residents independently taking part in a variety of activities, such as knitting, drawing, watching television, chatting in groups etc.. Residents are able to receive visitors and residents also visit family and friends. There is a 4 week menu plan showing a varied, nutritious and varied diet. The inspector observed the serving of the midday meal. Staff who prepared the food are aware of the individual tastes of the residents. Choice was very much available and individual tastes were catered for in detail. For instance, residents were offered a choice of fish and chips with vegetables, or two different types of sausage, or fried egg. One resident specifically asked for her egg to be fried until it was crisp which staff completed. All residents spoken to about the food stated that it was of a good standard. The inspector asked one resident, ‘what is your favourite meal,’ to which the reply was, ‘all of them.’ Residents help clear away the dishes and a few residents choose to help wash the dishes. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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, 19 and 20 The home ensures that resident’s health care needs are addressed and that personal care needs are met. Amendments are needed to the home’s policy and procedure for medication. Whilst the administration of medication was generally satisfactory certain procedures need to changed. EVIDENCE: Care plans include clear details for staff delivering any personal care. This includes assessments of any lifting and handling needs, personal hygiene etc. The agreement of residents to these plans is demonstrated by the inclusion of the resident’s signature agreeing to the plan. Residents confirmed that they have eye sight checks and records clearly showed that each resident has a regular appointments with the optician, dentist, chiropodist and that medication is regularly reviewed by the general practitioner. Staff were observed dispensing medication. This was satisfactory although the procedure needs to be improved by the following: staff should refrain from actually handling the tablets, and the medication recording sheets should be completed immediately following the resident taking the medication. Medication is predispensed when a resident attends an activity. A record is maintained of this, but the home’s written procedure needs to be amended to include this. Short course medication was being transferred from the Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 14 pharmacist’s container into the NOMAD cassettes by the breaching of the seal. This made it difficult to check exactly what medication was being held in the NOMAD cassettes. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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) 23 Staff have a good knowledge of individual resident’s behaviour. There is an outstanding requirement for staff to receive training in dealing with behaviour where there may be physical contact. EVIDENCE: This standard was not assessed in depth and will be included in the next inspection. The inspector did check on progress to implement the recommendation in the last two reports for staff, or key staff, to receive accredited training in dealing with behaviours where there may be an element of bodily contact, such as that provided or recognised by the British Institute for Learning Disability. The home has not made any progress in arranging this training for staff. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.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, 25, 26, 27, 28 and 30 Whilst the home was found to be clean and many areas decorated to an acceptable standard there are a significant number of areas that require attention. Bathrooms are institutional in appearance and those in the lower ground floor in a poor state of repair to the extent that they do not promote residents’ dignity and self esteem. The home’s own refurbishment and redecoration plan has only been partially adhered to. Furniture needs to be replaced in certain bedrooms and bed linen was also found to be in need of renewing. The inspectors identified that the home’s physical environment is that aspect of the home’s operation that significantly fails to meet the standards required. EVIDENCE: Residents spoken to during the inspection described how they liked their bedroom. There are 5 single and 9 double bedrooms. The home submitted a decoration and refurbishment plan to the Commission. The timescales set for completion of works has not been followed and there are outstanding requirements from the last inspection report regarding the maintenance of the physical environment. There has been some improvement to the environment and items of furniture have been replaced in a number of Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 17 bedrooms as set out in the home’s plan. However, many items identified in the plan as in need of replacement have not been carried out, such as, replacement of chairs in rooms 11,7 and in room 10 the replacement of the bed, chair and wardrobe. Bedrooms have been personalised by residents who were observed making use of their bedroom for hobbies. Bed linen was found to be worn and in need of replacement in bedroom 11. There were no curtains in one bedroom. This was said to be the result of one of the room’s occupants. The inspector was informed that the other room occupant did not mind this. Fortunately the room is not overlooked. The damaged wallpaper in room 10 has not been repaired as required by the last report. There is also damage to the paintwork on the walls leading to the third floor. The manager explained that both these areas of damage are caused by a leak from the roof. The ground floor is in need of particular attention. The maintenance programme scheduled the walls and paintwork for redecoration by April 2005, but this has not taken place. The toilet and bathroom in this area is in a poor state of repair. The floor is damaged, toilet seats are in need of replacement, paintwork is chipped and marked; these facilities do not enhance the dignity of the residents. There is one double bedroom on the ground floor. This was scheduled for redecoration by April 2005 and whilst the inspector was informed that there has been some repair to the paintwork redecoration has not taken place. Residents are unable to see out of the windows of this room as all the glass is frosted. This also inhibits light coming into the room. The inspector suggested that this room could be greatly improved by the replacement of the frosted glass by clear glass, with net curtains or blinds for privacy. It is a national minimum standard that residents’ bedrooms have a window with a view, which is not possible in this room. As well as decorative and structural defects , many areas could be improved by minor maintenance work. For instance, fibreboard radiator covers have been installed but have not been painted. These are becoming stained and cannot be wiped clean due to the porous surface. Bathrooms would look less stark in appearance if they were decorated and furnished in a more homely manner. Wall mirrors have been removed in at least one bathroom and the brackets left; this looked unwelcoming. Residents were observed using the lounge areas as well as the garden. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 18 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) 33 and 34 The previous inspection report required that staffing levels are increased and it was found at this inspection that the opposite has occurred: they have been reduced. Staffing is not provided at levels to meet the needs of the residents. Procedures are in place to ensure that staff recruitment procedures protect residents and that suitable staff are employed. EVIDENCE: At the time of the inspection there were 2 care assistants, 2 cleaners and the manager on duty. The staff rota was examined for the week commencing 3rd. July 2005, which showed the provision of 358 staff hours. This included the hours worked by the home’s management. The home accommodates 22 residents: 11 with ‘low’ and 11 with ‘high’ needs. The Residential Forum Guidance advises the provision of 639 hours for this client group. However, this in not a requirement for existing homes, only a best practice ‘target.’ At the last inspection the home provided 411 care staff hours. A requirement was made to increase this. The rota shows that at various times there are only 2 care staff on duty which is insufficient for 22 residents. Greater staff provision will allow staff to facilitate and provide activities such as trips out, independent living skills etc. Recruitment procedures were found to be of a good standard. These were checked for a recently appointed staff member. Suitable checks had been carried out, including criminal record bureau (CRB) and protection of Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 19 vulnerable adults (POVA) checks. Two written references were available including one from the person’s most recent previous employer. There was a record of the person being interviewed. The inspector was able to confirm with the staff member that she had been interviewed, that references had been taken, and that she had submitted application forms for CRB and POVA checks. The inspectors spent time talking to one of the staff who showed a commitment to the work and the rights of the residents. She had a thorough knowledge of the residents’ needs and choices. Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 20 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) Non e of the standards in this section were assessed at this inspection. EVIDENCE: Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 21 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 3 x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 2 1 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 2 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Summerlands Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 22 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 20 Regulation 13 (2) Requirement The homes procedure for the receipt, recording, storage, handling,administration, and dispsal of medication must include those procedures where medication is predispensed for residents to take to day centres. This is outstanding from the previous inspection report. The home must cease to predispense medication from pharmacists containers into NOMAD cassettes, including the breaching the sealed cassettes. this medication must only be dispensed from the pharmacists container. You are required to review staffing levels and to produce evidence that there are enough suitably trained staff on duty to meet the needs of the residents. This is outstanding from the previous three inspection reports. This has been referred to the inspectors line manager. Written confirmation must be sent to the Commission outlining how this standard is to be achieved. The wardrobe must be replaced Timescale for action 8th. September 2005 2. 20 13 (2) 8th. August 2005 3. 33 18 (1) (a) 8th. September 2005 4. 26 16 (2) 8th. Page 23 Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 5. 24 23 (2) (b) 6. 7. 26 27 16 (2) 23 (2) (b) in bedroom 11 by 8th. September 2005. This is outstanding from the previous inspection report. The damaged wallpaper in room 10 must be repaired by 8th. September 2005. This is outstanding from the previous inspection report. Written confirmation must be sent to the Commission by 8th. September 2005 detailing repairs needed to the flaking paintwork on the stair wall to the third floor. Repairs must be completed by the end of 2005. Residents must be provided with bed linen that is not worn. Written confirmation must be sent to the Commission that the ground floor toilet and bathroom will be redecorated and refurbished as necessary by the end of 2005, and that the ground floor hall will be redecorated by the end of 2005. Mirrors must be provided in bathrooms. September 2005 8th. Septemebr 2005 8th. October 2005 8th. September 2005 8. 27 23 (2) (b) 8th. September 2005 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 23 Good Practice Recommendations Staff should attend recognised and accredited training in working with residents who exhibit aggressivbe behaviour. This is outstanding from the previous two inspection reports. Frosted windows in bedrooms should be replaced by clear glazing witht provision of net curtains and/or blinds so that residents rooms have adequate light and a view. 2. 26 Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 24 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 © 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 Summerlands H55-H03 S11856 summerlands V220284 080705 stage 5.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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