Inspection on 07/08/08 for Summerville

This inspection was carried out on 7th August 2008.

CSCI found this care home to be providing an Good service.

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

Summerville 08/10/07

Summerville 09/08/06

Summerville 10/02/06

Summerville 21/06/05

Summerville 20/12/04

Summerville 12/07/04

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Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Summerville 39 Prices Avenue Margate Kent CT9 2NT Lead Inspector Wendy Gabriel Unannounced Inspection 7th August 2008 10:00 Summerville DS0000028712.V369576.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 Summerville DS0000028712.V369576.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. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerville Address 39 Prices Avenue Margate Kent CT9 2NT 01843 295703 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) Manor Care Homes Rosario Vethanayagam Care Home 4 Category(ies) of Learning disability (0) registration, with number of places Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability (LD) maximum number of places 4 The maximum number of service users to be accommodated is 4. Date of last inspection 8th October 2007 Brief Description of the Service: Summerville is a large detached property providing accommodation on two floors. All bedrooms are single. The Home is situated in the seaside town of Margate and is within walking distance of some of the local amenities. There is a mainline railway station in the town and other public transport. There is a pleasant walled garden to the rear of the property with parking for 3-4 cars. Unlimited off street parking is available. The current fees for the service at the time of the visit range from £1201.00. £2877.10 per week. Extra charges are payable for personal items such as: clothes, toiletries, extra leisure and social activities, therapeutic sessions (aromatherapy, yoga, music therapy). The home pays for one holiday a year. For further information, please contact the registered provider. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We looked at the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. We spoke to the registered manager and two members of staff. An accompanied tour of the premises was undertaken and some records and documents were viewed. Four surveys were received from staff and one survey was completed on behalf of a service user by a parent. The premises were clean and homely and the registered manager provided a range of documents regarding health and safety in the home and records about the service users and their individual needs. The registered manager has met the requirements made at the last inspection. The registered manager has previous experience as a trainer and this was evidenced by a robust staff training matrix. Staff also confirmed that there was a wide range of training always available. Staff said they appreciated the small numbers of service users living in the home as they were able to really get to know them and be very aware of their needs and preferences. An independent health and safety consultancy has written about the service in May 2008 that a ‘high level of compliance to current legislation was evident and all involved should be congratulated for their effort’. What the service does well: Training is a high priority for the registered manager and there was a wide range of training certificates on display. The home has a mostly established staff team and this consistency is beneficial to the service users who have complex needs and communication limitations. The home maintains a male/female ratio of staff to meet the current service users needs. The registered manager has identified maintenance issues around the home these are recorded and are due to be undertaken. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Summerville DS0000028712.V369576.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 Summerville DS0000028712.V369576.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 Prospective service users needs and aspirations are assessed and they or their representative are given information to help make an informed choice about where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home usually receives referrals from care managers or the community nurse. Discussions take place with the family and involved health care professionals and then the prospective service user will be visited. The registered manager makes an assessment and visits to the service will be made. During this time the assessment will continue especially with regard to how the prospective service user interacts with the people who live in the home. Any previous assessment from a care manager or a previous placement will also be used to get a good picture of the needs of the prospective service user. The registered manager states in the AQAA that ‘The revised Statement of Purpose & Service User Guide include compliance with legal requirements & National Minimum Standards. A service user has been given a copy of the Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 9 extracts of SOP & SUG which is simple and user friendly. Similarly, the relatives have been provided with their own copies’. A c.d. version of the statement of purpose is also available. Summerville DS0000028712.V369576.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): 6,7,9. Quality in this outcome area is good. Service users are enabled with assistance to be involved about decisions in their lives and identified risks are supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has clearly written care plans that contains a variety of information including guidelines for behaviours and risk assessments. Daily reports are maintained. Records are regularly reviewed and two care plans seen had evidence of health needs being addressed. Support and advice from health care professionals is sought such as psychiatrist, epilepsy consultant and community nurses. Person centred plans have been started and indicate a selection of choices about daily living. Each person has a key worker and a co-key worker. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 11 The home maintains a separate folder for individuals regarding particular health care needs. A detailed folder is kept for if a service user should go to hospital and this details, in the first person, needs and preferences. Risk assessments are detailed and give clear instructions to staff to deal with issues. There is also evidence of activities including college or training venues. Rather than undertake challenging behaviour training regarding one service user, the home sought advice from a behavioural specialist and the registered manager said that this has worked very well and behavioural guidelines now support the individual. Some surveys received from staff confirm that records are reviewed and kept up to date. Summerville DS0000028712.V369576.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): 12,13,15,16,17. Quality in this outcome area is excellent. Service users can undertake appropriate activities in house or the community and family involvement is encouraged. Rights and responsibilities are recognised. Menus suit the needs and choices of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Current service users have limited communication skills but can understand some speech and, as described by a member of staff, some signing. One person attends college and has undertaken art and drama, gardening and cookery, because this person has progressed in ‘leaps and bounds’, they have been given an award by the college for such good progress. A new venue for activity /work has been accessed for one person in a nearby town and this will be undertaken weekly. Other people have access to outings and some formal activities with support of staff but their needs and Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 13 preferences limit a greater choice. Staff were very understanding of different needs and how best to encourage people to enjoy aspects of activities that may be undertaken. The staff and the registered manager spoke about the sensory room that is currently being set up in the vacant bedroom. This was also mentioned in a survey received from a parent. Staff feel a little disheartened because it will eventually have to be moved when the vacancy is filled. All parties said how much it benefited service users. The registered manager said she would like to see a dedicated area, perhaps a chalet or summerhouse in the grounds to be set up permanently for service users. As the benefits have been clearly recognised it is to be hoped that the registered provider will make provision for this. The sensory room has also become an art room with evidence of art work being undertaken. The home had examples of different service users art around the walls. An aromatherapist visits weekly and one person was attending a weekly music therapy session with a teacher in house. The staff take a lot of pleasure in having parties and bar-b-ques for service users and their families and there were photographs of these being enjoyed. Staff and the registered manager said families are very involved in the home and that staff appreciates this because it is another source of activity for service users. There is a four-week seasonal menu. The fridges and freezers were full and there was ample fresh fruit and vegetables in the home. One person has a particular diet that has been documented. The dietary advice was given following consultation with different health care professionals. Summerville DS0000028712.V369576.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): 18,19,20. Quality in this outcome area is good. Service users physical and emotional needs are supported in the way they prefer. Medication administration practice will be more secure when risk assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care planning gives detailed guidelines to meet the preferred and assessed needs of service users. Physical and emotional needs are assessed and reviewed regularly. There is written evidence of interaction with health care professionals regarding different aspects of service users care. Staff were heard reassuring a service user who had become anxious about an activity. This was done immediately they recognised the triggers that were in the individuals’ guidelines and was undertaken promptly and kindly. Staff undertakes medication administration training and certificates were seen on display in the office. Medication is secured in a secure, dedicated cabinet. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 15 The medication was well organised and administration records were in order. Medication administration charts include details of medication given as needed and reasons for this. Two people undertake the administration, one as an observer and second signature. There was written evidence of medication being reviewed and changed by a health care professional to meet changed needs of service users. The member of staff undertaking the administration was very aware of cleanliness and security. Medication was put into pots to take to service users individually during the lunchtime administration. The registered manager explained that this was done because the health and safety issues of the current service users made it the safest method of administrating the medication. Good practice suggests that an individual risk assessment should be in place about this issue and the registered manager agreed to this. Summerville DS0000028712.V369576.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): 22,23. Quality in this outcome area is good, Service users are protected from abuse by the homes policies and procedures and by staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home maintains policies and procedures on complaints. A survey from a parent confirmed that they had been given a copy of the procedure. A complaints notice is on display. The service users guide includes a simple explanation of how to make a complaint. Regulation 26 (a monthly visit to the service and report by a representative of the company) is undertaken. The service undertakes quality assurance questionnaires and collates the findings. Staff undergo recruitment checks including references and CRB checks. Management guidelines are in place for self injury. Staff receive training on understanding adult abuse. Staff said they would be confident about reporting any incidents or suspected incidents of abuse. Since the previous inspection the home records & files a translation of expressions (a service user becomes repetitive about incidents). These were viewed and details clearly describe any incident. A whistleblowing policy is in place. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 17 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): 24,25,30. Quality in this outcome area is good. Service users benefit from a clean and well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and tidy and was a homely environment with comfortable furnishings and decoration. The registered manager had a detailed repair and maintenance plan with areas identified for redecoration or maintenance. The home has employed an independent health and safety consultancy to inspect their premises this year. The report stated that a ‘high level of compliance to current legislation was evident. All involved should be congratulated for their effort’. A bare panel below a boiler in the kitchen is to be re-covered as soon as possible. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 18 The kitchen was clean and tidy and a member of staff was working in there preparing the days meal. The fridge and freezers had a good supply of food and there was a supply of fresh vegetables and fruit. The laundry area and adjacent staff toilet and washbasin is due to have new flooring as the old washing machine had a leak. The washing machine is capable of high temperatures to meet infection control. There are two lounges and one dining room. A music therapy lesson was undertaken in one lounge during the morning. The vacant bedroom is being converted to a sensory room and the registered manager and staff are bringing in a variety of lights and sensory and tactile objects. This report has already indicated that a sensory area for the current service users is a valuable asset to them. The registered manager, staff and comments from a parent confirmed the importance they put on this facility. Bedrooms are spacious and equiped to meet the individual needs of service users. A letter was seen from the environmental health officer in June 2008 indicating that asbestos had been found on the property. The registered manager confirmed that this had been seen to by an appropriate person and that the final report had not yet been received. The garden is a pleasant and accessible area and there was photographic evidence of a service user enjoying gardening. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. Service users benefit from well trained staff and by recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two staff spoke about their roles in the home. Both liked the smaller numbers of service users as they said it meant they have the opportunity to get to know them very well and become fully aware of their needs. Both staff said they had undertaken a lot of training and that the registered manager was very keen on providing not only mandatory courses but also other training pertinent to the needs of the current service users. Two staff files were viewed and these contained suitable recruitment records including criminal record bureau checks. References are sought and followed up with telephone conversations. Staff comments received indicated generally that induction was suitable and that supervision is taken regularly. Records of supervision are maintained and were viewed. Induction is through skills for care and the learning disability framework. Staff receives a copy of the employee handbook and health and Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 20 safety handbook when they commence work at the home. They also have a medication assessment manual towards their training. The registered manager confirmed that since the previous inspection the staff ratio for 1:1 and sometimes 2:1 support for some service users has been met. The AQAA states that ‘staffing levels are reviewed regularly to reflect the service users changing needs example, behaviour changes require more staff input (extra staff rostered)’. Staff comments in the surveys received were generally positive about the home but all said that staff moral is low due to a five-year period of no salary increments. A member of staff and the registered manager reiterated this. The registered provider should address this to ensure staff do not leave for better prospects elsewhere. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 21 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): 37,39,42. Quality in this outcome area is good Service users benefit from the management and administration of the home and know their health and safety and welfare is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked with people with learning disability since obtaining her nursing qualification in 1978 and was a registered home manager in the 80’s and 90’s and has gained both management and NVQ4 qualifications in the health service and private sector. The registered manager is also a qualified tutor and NVQ assessor. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 22 There was good evidence of recording being properly organised and reviewed. Quality assurance is now undertaken and findings from comments received are collated. The home now has a business development plan. This meets a previous requirement. A member of staff was observed getting money from cash held of a service user. Robust records were maintained and a sample of cash held corresponded with records. A monthly audit of financial records is undertaken and a member of staff said that the record trail would indicate who was responsible if any part was not accurate. One written comment from a member of staff stated that supervision was ‘torture’ if the registered manager was in a ‘bad mood’. But other written comments by staff were more positive such as the registered manager is very active and keen on all aspects of service users needs and communicates well to all carers on how to meet these. One member of staff wrote that they were well supported when starting in the job. A written comment from a family member stated that ‘most staff knows (name) well, this is so important, staff do a great job with (name)’. A health care professional wrote that ‘(name) receives a service that is geared to their needs’. Another wrote that the home ‘facilitates good community access and client holidays’. Health and safety is assessed by an independent consultancy. The registered manager seeks training and up to date information from different sources including the University of Kent, behavioural specialists and Kent and Medway NHS and Social Care Partnership. Health care professionals are regularly accessed to meet the needs of the service users. Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 23 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 24 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. 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 Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Summerville DS0000028712.V369576.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!