Inspection on 22/03/07 for Swerford House

This inspection was carried out on 22nd March 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swerford House 24/02/06

Swerford House 23/08/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Swerford House Swerford House The Avenue Temple Ewell Kent CT16 3AW Lead Inspector Julie Sumner Key Unannounced Inspection 22nd March 2007 10:00 Swerford House DS0000062504.V307181.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 Swerford House DS0000062504.V307181.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. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swerford House Address Swerford House The Avenue Temple Ewell Kent CT16 3AW 01304 821432 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) High Quality Lifestyles Limited Mr Michael Harrison Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On vacation of bedroom 4 by service user whose date of birth is 09/09/1981 the sink facility should be reinstalled. 24th February 2006 Date of last inspection Brief Description of the Service: Swerford is a home for people with learning disabilities and communication difficulties who present challenging behaviour at times. The home is owned by the private company: High Quality Lifestyles. The companys philosophy is to support people who have displayed behaviour that has caused them and others difficulty and has limited ordinary/usual kinds of life opportunities by positive guidance and a specialised environment. Swerford is registered to provide accommodation for up to 5 people. The current fees for the service at the time of the visit range from £1885.00 to £3110.00. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address for the home is swerford@hqls.org.uk. The home is a detached property set in spacious grounds on a hill in Temple Ewell, a village mid way between Dover and Folkestone. It is a semi rural area and the home provides transport to ensure the service users are able to access facilities in Dover or Folkestone and pursue a variety of activities. The local bus route is on the main road just down the road from the home. The bedrooms are single and are decorated to suit individual needs and preferences. Communal rooms are light and spacious. The home is decorated and furnished to suit the individuals living in the home. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. Swerford provides a safe, spacious and homely environment for service users. The inspector visited the home to talk to service users and staff and view records and practices. The time spent in the home overall was around 5 hours. Information was gathered for this inspection by a variety of means both prior to and during the visit to the home. The CSCI request information from the home routinely and the home manager provided all the information requested in the pre-inspection questionnaire prior to the inspection visit. The home received feedback about the service provided from relatives and visiting professionals all comments were positive. There was one outstanding requirement from the previous inspection and this has been carried over again. 1 requirement and 4 recommendations were made as a result of this inspection. What the service does well: Service users are provided with a calm environment that is clean, spacious and clutter free. Staff continue to give service users lots of positive attention and support individuals with different activities. Service users are guided to go out shopping and pursue sport and leisure activities. New experiences are introduced gradually, a bit at a time, out in the community depending on each person’s ability to cope and what they like to do. There are support strategies and diversion techniques to develop methods of communication and social skills as an alternative to challenging behaviour. Plans for support are written to make sure all staff know how each person needs to be guided and what they like to do. These are currently being developed using a format that looks at wishes and support needs from an individual perspective and using pictures and language more easily understandable for people with learning disabilities. Service users receive constructive support from staff to guide behaviour and develop social and communication skills with good, clearly written plans. Clear records are kept to discretely measure progress and effectiveness of support in reducing socially limiting behaviour and increase opportunities. Where it is indicated in the agreement between the home and the care managers for one or more members of staff to give individual support, this is given consistently. Swerford House DS0000062504.V307181.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. Swerford House DS0000062504.V307181.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 Swerford House DS0000062504.V307181.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 at least once during a 12 month period. 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. Prospective service users needs and aspirations are assessed by a person who has the skills, knowledge and insight to ensure that that the homes will be suitable and be able to meet the needs of the service users. EVIDENCE: There has been one new admission since the last inspection. The assessments carried out by the registered manager were viewed and discussed. Risk assessments and an initial service user plan had been written with staff contributing to the information being recorded as they are getting to know the individual. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users know that their views are listened to and that their personal goals are reflected in their individual plans and potential risks are managed. Good progress is being made to design person centred plans to run alongside these. Service users receive good support to develop social skills and overcome communication difficulties. Risks are identified, recorded and minimised ensuring that service users are protected and kept as safe as possible. EVIDENCE: As with other homes in the company Swerford is currently changing the style of the service user plan to make it person centred. Each service user is having a review to initiate this. One of the newly compiled person centred plans was viewed and discussed with the registered manager. It highlights what is Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 10 actually important to the service user and uses pictures, colour and direct language. Service user plans are reviewed every six months and more frequently if needs or circumstances change. Records are kept to monitor effectiveness of support and modify the guidelines for support as needed. The service provided in the home was observed to be service user lead. Staff were observed responding to service users’ wishes and supporting them with chosen activities. The manager and staff talked about getting to know the way individuals with limited verbal skills communicate their needs and wishes. Definitions of different words and interpretation of some behaviour used by one individual is included in his person centred plan. Risk assessments are in place for all relevant circumstances and have been designed to provide appropriate staff support when out in the community. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to go out with appropriate support and develop skills to cope with and enjoy different opportunities in the community. Service users are enabled to go on holiday if they wish. Service users are supported to go out and exercise to relieve tension and keep fit and healthy. Contact with service users’ families and friends is encouraged and supported. Service users are provided with a good range of meals and are able to choose where and when they want to eat. EVIDENCE: Service users are given the opportunity to participate in the tasks carried out as part of running the home on a gradual basis introducing experiences and assessing progress. There are some established activities that service users Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 12 enjoy and these are indicated in the service user plan. Service users like going out for lunch and one service user went out during the visit. Activities are also introduced on an experimental basis to give individuals the opportunity to try something new. A range of activities are participated in from walks in the local area to having a meal or drink in a café. One service user also likes swimming including in the sea. At present all service users go out individual with one-to-one or one-to-two support. The home works together with service users’ families. Relationships with relatives are supported and encouraged. There are communication books for relatives and staff to write comments between visits and outings with their families. Service users are free to access all areas of the home and grounds, excluding other people’s bedrooms. Where there are identified risks, for example, in the kitchen these are assessed regarding any necessary limitations on access. Each service user is offered their own key to their bedroom so that they can lock it. Staff have overriding keys in case of emergency. Staff take it in turns to prepare the meals. Service users have the opportunity to assist with some of the preparation in relation to their risk assessment. The menu was varied and service user likes and dislikes were taken into account. Service users were observed being supported appropriately and sensitively whilst eating their lunch. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ preferences in how they are supported are taken into account. Service users are supported to access health and medical services to maintain a healthy lifestyle and receive appropriate treatment when needed. Service users have medication only if necessary to assist with the support given to promote and maintain their health and wellbeing. EVIDENCE: Each service user has one-to-one support. Staff were observed supporting each individual in a different way depending on what support they needed and interaction observed was service user led. Guidelines for support are included in the service user plan of care. There has been a general discussion with managers in the company that due to the service users’ challenging behaviour that the homes specialise in supporting it would be preferable to have more staff trained in the approved first aid course. At present the registered manager and a senior member of staff have attended. The company plans to train all staff who are usually shift Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 14 leaders so that there is always someone in the home who has received this training. This would also comply with HSE guidance. All service users are registered with a GP and go down to the surgery for arranged appointments with support of staff. There are health check update sheets which are completed for every incident related to individual health and kept in a folder for reference. A sample of health records were viewed and discussed. The home uses a monitored dosage system. Medication administration, storage and records were viewed. Part of the lunchtime administration was observed. Staff administering medication have attended medication training and this was also included on the training plan viewed. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 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 the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective complaints procedure. Service users are supported and encouraged to communicate their wishes. There is an effective financial procedure and systems to safeguard service users’ money. There are effective procedures in place to protect service users from risk of abuse. EVIDENCE: There is a complaints procedure but there has been no further progress on a written complaints procedure for service users. However, the home are continuing to develop communication methods and relationships between key workers to interpret service users’ wishes and make sure if they are unhappy about something it is responded to. The homes financial procedures were discussed and records viewed. Only the manager and one other member of staff hold keys to the safe where cash tins are kept. Each service user has a bank account with a passbook and additional records are kept of all transactions with two signatures when money is spent on behalf of individuals. Service users mostly have other representatives or family members as appointees. The manager keeps care managers informed regarding individuals’ accounts where there is no other external appointee. All procedures and money is audited by the company administrator and is included in the monitoring visits. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 16 Adult protection training is included in the induction training and further refreshers are included on the training plan. All new staff have had the induction training and existing staff have attended the refresher course. Staff were aware that there is an adult protection procedure and what constitutes abuse. As staff read the homes procedures they sign that they have read and understood. Swerford House DS0000062504.V307181.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A homely and practical environment has been created that service users are comfortable in. The home was clean throughout. There is a good size laundry room with appropriate equipment to meet service users’ needs. EVIDENCE: A tour of the home was undertaken with a member of staff. The home was clean and well maintained. The roof is currently being repaired. The home has been designed to maximise space and light and provides a good environment with enough different areas for service users to move around and not always be together. All the furniture has been purchased to suit individual needs. Some furniture has been specially made including an extra sized bed and a leather suite with removable covers. All service users have their own bedroom and these have been decorated and furnished personally. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 18 Outside the garden is well maintained. There are several different areas for service users to go. In one area there is a trampoline and some outdoor beanbags. The perimeter fencing is badly damaged and in need of repair. This has been damaged for some time and could pose a risk for service users safety and security a recommendation has therefore been made to repair it. Swerford House DS0000062504.V307181.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have a strong commitment to enabling service users to develop their skills, including social, emotional, communication, and independent living skills. A robust recruitment process protects service users. Service users benefit from an enthusiastic and supportive staff team. The NVQ training programme is underway. A good range of training is provided to meet individually assessed needs. A review of the induction training would make it more effective. EVIDENCE: A sample of staff files were viewed. The focus was on checking the recruitment process for the most recently recruited staff. The manager was aware that it was necessary to receive POVA clearance prior to staff starting work in the home. There was evidence of CRB and POVA checks being carried out and references being obtained prior to employment. The company have employed a new training manager and reviewed the training provided. There has been a significant increase in the training Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 20 provided overall. This has enabled the manager to ensure that staff have up to date mandatory training as well as other training considered necessary to provide staff with the skills to support the service users. The registered manager and another manager in the company provide SKIP training and this has ongoing with new staff receiving the training and more experienced staff having refresher courses again. Three senior staff are attending the person centred approaches training at the Tizard Centre. NVQ training has progressed. NVQ training is on target to achieve 50 by the time the current group have finished studying. All new staff have received induction training. The induction training pack was viewed and discussed with the registered manager and needs to be reviewed in line with the new general induction standards. A recommendation has been made for this. Swerford House DS0000062504.V307181.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. There is a clear vision and clear direction to develop the service. Development of the quality assurance monitoring system would determine whether the service being provided in the home is what service users want and is meeting their needs. This would provide the basis for the development plan for the home. The home has a good record of meeting health and safety requirements. EVIDENCE: The registered manager has over two years experience in management and has completed NVQ 4 in management and care. HQL has designed a training programme for the senior staff to provide them with specialist skills to support Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 22 people who display challenging behaviour. The registered manager is currently studying the second year of this course. The company has not developed the quality assurance system yet, although management staff have recently been employed to design and implement this. Records written and kept in the home will feed into this system. Regulation 26 visits have been carried out monthly by a company representative. A sample of maintenance records were viewed. The fire log was completed and up to date. The manager has an updated version of the fire risk assessment. The updated environmental risk assessments were viewed. Mandatory training is ongoing and up to date. Swerford House DS0000062504.V307181.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 3 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 2 x x 3 x Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 YA39 Regulation 24(1) (a,b(2(3 Requirement To set up a quality assurance audit system within the company to measure success in achieving aims and statement of purpose of the home based on views of service users and their representatives. System structure and planned implementation to be completed by timescale. (previous timescale March and May 2006) Timescale for action 29/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations Make sure that there are sufficient staff on duty with approved first aid training in line with HSE ratios of staff to service users and having assessed the needs of the service. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 25 2. 3. 4. YA24 YA32 YA35 The perimeter fencing needs to be repaired. Continue to provide NVQ training and work towards achieving 50 of the workforce having NVQ 2 or above. The Skills for Care general induction elements need to be incorporated into the induction training. Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Swerford House DS0000062504.V307181.R01.S.doc Version 5.2 Page 27 - 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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