Inspection on 14/12/05 for Sycamore Court

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sycamore Court 27/09/06

Sycamore Court 20/07/05

Sycamore Court 22/11/04

Sycamore Court 01/07/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Sycamore Court 33 Robert Hall Street Leicester Leicestershire LE4 5RB Lead Inspector Paula Dutton Unannounced Inspection 14th December 2005 02:30 Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sycamore Court Address 33 Robert Hall Street Leicester Leicestershire LE4 5RB 0116 2610663 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) Leicester Housing Association Ms Dawn Cooke Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 20th July 2005 Brief Description of the Service: Sycamore Court is a Registered Home for Adults with Learning Disabilities and is situated near to many amenities, including shops, pubs, sports facilities, bus routes, canal and parks. The house offers main residential accommodation, and has an annex with a kitchen and three bedrooms for residents who are more independent. The accommodation is on two floors, including bedroom and communal rooms. There is a large enclosed garden to the rear of the property, with direct access from the communal lounges. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of three and a half hours. The manager was available for part of this inspection. Most of the residents residing at Sycamore Court were present for part of the inspection. Four residents were consulted for their opinions and one resident was observed. One new member of staff was interviewed and the medication cupboard was viewed. Two residents’ files were viewed. Observation took place of the main communal areas. This process of gathering information is known as ‘case tracking’. What the service does well: This is a very well managed service. Some strengths within the service include: • • • • Staff commitment to completion of a programme of training including National Vocational Qualifications and the Learning Disabilities Award Framework. A working approach for the promotion of protecting vulnerable adults throughout all activities supported by the home supported by risk assessment for vulnerabilities. Effective communication through use of tools to promote careful sharing of information. Stability within the resident group and staff team promotes a sense of community. Some comments were received from residents. All comments reflected total satisfaction with the services: • ‘The staff are nice’. • ‘we get on well with staff’. • ‘Joy is a nice lady’. • ‘My bedroom is good’. • ‘Staff sit in the office at night’. A relative commented to the inspector: ‘It’s brilliant – he’s been brilliant since coming here. I’ve got no complaints’. What has improved since the last inspection? What they could do better: Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 6 There were no shortfalls identified during this inspection therefore there were no statutory requirements or recommendations made. Discussion took place about some issues to which an assistant manager agreed actions to be taken. These were: • To review care plans when needs significantly change. • To address mental health needs within a care plan. • To review risk assessments for challenging behaviour to establish if a risk assessment is appropriate and necessary. • To name the behaviour identified as ‘challenging’ within a risk assessment. • To remind all staff in expected recording accidents/incidents at the next staff meeting. • To facilitate a residents’ meeting to consult about the operation of the home. 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. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 Information is exchanged between the potential resident and the home to enable each party to make an informed decision. EVIDENCE: The home operates an open and friendly atmosphere. Visitors are welcomed to the home. Information is available in the Statement of Purpose and Service Users’ Guide for all enquirers to read. A new member of staff confirmed this document is made available to all residents. Evidence indicated the home gains social work assessments prior to admitting residents and then work closely with residents, relatives and social workers to ensure a positive process of assessment and introduction to the home. A trial period is available for residents to sample living at the home before becoming permanent residents. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Residents are assisted through care planning and risk assessment to make safe choices about their lifestyle. EVIDENCE: Two residents’ care plans were viewed within individual record files. Both files contained detailed care plans with actions stated as to how staff were expected to meet those identified needs. Discussion took place regarding one care plan which was due for review which did not represent the needs of the resident accurately. The duty officer stated this would be addressed promptly and care plans are usually altered as and when needs change. Evidence was seen of a range of risk assessments which addressed activities chosen by residents that may present risk. These included safety in the community. Risk assessments identified aspects of each residents’ care needs that resulted in increased vulnerability. This is good practice. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 10 Discussion took place about a risk assessment for a resident who presented ‘challenging behaviour’. The duty officer agreed to review this risk assessment and to name the behaviour identified as challenging. All information relating to residents was stored securely and individually. Residents were aware of the records kept in lockable storage. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 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): 15, 16, 17 Residents are able to make choices about their lives and relationships. EVIDENCE: Most of the residents living at the home expressed an opinion or were observed by the inspector. Residents were able to express their views freely to each other and to staff. Observation found residents are able to make requests of staff and to enquire about particular activities. Residents were able to move around the premises without restrictions and chose which activities they wished to participate in. Some residents talked about relaxing in the home after completing a full term at college. Some residents were aware they could participate in decorating the pine needle Christmas Tree. All residents gathered together for tea time. Choices were offered to residents by staff. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 12 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): 20 Residents receive their medications safely so that their health and welfare is protected. EVIDENCE: The home has a policy and procedure for the safe administration of medications. The manager stated staff are booked to attend an accredited training programme entitled ‘Safe Handling of Medications’ which is a twelve week course. The medications are stored securely in a lockable cupboard. All medications are supplied individually in a Monitored Dosage System or ‘blister packs’. A sample check was completed for two residents. A member of staff stated all staff have access to manufacturers’ advice notes and to the British National Formulary reference book. Each individual record held a photograph of the recipient. Daily notes on residents’ record files showed careful recordings are made of changes in medications and any relevant health care consultations. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 13 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 Residents are able to express their views and have their rights protected. EVIDENCE: Residents expressed complete satisfaction with the services offered and with the performance of staff. Observation found residents are able to make requests of all staff and expect to be listened to effectively. Evidence was seen of previous residents’ committee meetings. A member of staff agreed to discuss with the manager the need for a residents’ meeting in order to consult with all residents about the operation of the home. The home has a policy and procedure for the prevention of abuse of vulnerable adults. A Whistleblowing policy and procedure was available for all staff to access. Most staff have completed a National Vocational Qualification in care which includes exploring the different types of abuse and how to identify abuse. The home operates a risk assessment system to address all activity undertaken by residents which also features their vulnerability and how best to protect each resident. This is good practice. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home is clean, pleasant and homely. EVIDENCE: A tour of the main communal areas found the home is clean and tidy. Observation of communal toilets found they were maintained and were hygienic. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36 Training, support and supervision provided to staff ensures residents’ needs are met safely. EVIDENCE: The home offers all new staff a programme of induction training. A new member of staff confirmed work had been completed towards his induction training programme. The staff team over all have worked very hard to complete a National Vocational Qualification and the Learning Disabilities Award Framework. This is good practice. Evidence was seen of formal and recorded supervision offered to all staff. This process enables workers to reflect on their care practice. This is good practice. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 16 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, 42 Residents receive a well managed and safe service. EVIDENCE: The manager has more than two years of experience as manager and can demonstrate a very good working knowledge of the issues affecting people with learning disabilities. The manager has a good understanding of the National Minimum Standards and how the home achieves them. The manager offers clear guidance and leadership to the staff team but also offers a close understanding of the issues affecting staff by often working within in the home with the residents. This is good practice. There is a comprehensive system of risk assessment for the premises and for the welfare of each service user. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 17 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 3 X 3 3 X Standard No 22 23 Score 3 4 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X 4 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sycamore Court Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000006315.V272509.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Regular checks should be undertaken of the medications cupboard to ensure that medication is fully and correctly labelled. Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 Sycamore Court DS0000006315.V272509.R01.S.doc Version 5.0 Page 20 - 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!