Inspection on 28/02/06 for Sycamore Heights

This inspection was carried out on 28th February 2006.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Heights 24/07/08

Sycamore Heights 08/08/07

Sycamore Heights 28/09/06

Sycamore Heights 28/02/05

Sycamore Heights 13/07/04

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 Sycamore Heights 89-91 Priest Avenue Canterbury Kent CT2 8PP Lead Inspector Jenny McGookin Announced Inspection 28th February 2006 10:00 Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 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 Heights DS0000023712.V276827.R01.S.doc Version 5.1 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 Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sycamore Heights Address 89-91 Priest Avenue Canterbury Kent CT2 8PP 01227 471074 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) priestgrove@mccn.org.uk MCCH Society Limited Mr Alan John Jones Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. [By 2005] has a qualification, at level 4 NVQ, management and care or equivalent; 5th October 2005 Date of last inspection Brief Description of the Service: Sycamore Heights is registered to provide care for up to six people with a learning disability, though the intention is to restrict this to four. The registration certificate will require amendment to reflect this, in due course. The registered provider is Maidstone Community Care Housing Society Ltd (hereafter referred to as MCCH), which is a registered charity / industrial and provident society. The property is separately owned by Sanctuary Housing Association, which is registered with the Housing Corporation under Section 1 of the Housing Act 1996. MCCH is effectively acting as an agent for Sanctuary Housing Association for the shared tenancy agreements it has with the residents at Sycamore Heights, and shares a key objective with it, specifically the provision of housing accommodation with care and support. The property comprises two adjoining semi-detached two-storey houses, which have been converted into one. Although each has retained its original front door, a notice directs all visitors to Number 81. There are currently five single bedrooms. A sixth has been decommissioned, with the prospect of another being decommissioned. There is a choice of communal areas, including a visitors’ room. And there is a dedicated office for staff use. The home is not suitable for people with significant mobility impairment without substantial adaptation. There are gardens to the front and rear and unrestricted kerb-side parking at the front plus garage space for two vehicles. There is also a bus stop within close walking distance. The home is staffed on a 24 hour basis, and MCCH provides a “Visiting People Team” to ensure activities do not have to be cancelled for want of available staffing. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was used to check progress with matters raised from the last available inspection report (February 2005,) given their timeframes had run their course; and to reach a preliminary view on other aspects of the day-to day running of the home. This report should, therefore, be read in conjunction with the February report. The inspection process took just under seven half hours, and involved meetings with the manager and three staff (including a senior member of the Visiting Person Team). Feedback questionnaires from one residents and five relatives / visitors were taken into account, and interactions between staff and residents were observed throughout the day. The inspection also involved an examination of records and policy documents and the selection of one resident’s case file, to track their care. Three bedrooms were inspected for compliance with the National Minimum Standards on this occasion, along with communal areas / facilities. What the service does well: What has improved since the last inspection? All matters raised by the last inspection – required and recommended action have been addressed. This is judged a very satisfactory use of the inspection process. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 6 Two communal areas (i.e. what was previously a through lounge and dining room) have been swapped over to obtain, on the one hand, a more open, spacious aspect for the dining room (with provision at its far end for a second lounge facility - favoured by one resident in particular) and, on the other hand, a separate, more traditional lounge. And the new lounge area has been redecorated. Two residents, who by reason of age and attendant mobility impairment, were effectively taking this home outside its registration category, have been transferred to more appropriate living arrangements. The introduction of “Objects of Reference” for one resident with special communication needs, to support him to choose options for himself is judged likely to redefine his care package. This promises to set exemplary standards. 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. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 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 Heights DS0000023712.V276827.R01.S.doc Version 5.1 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, 5 1. There is an adapted Statement of Purpose and Service User Guide to help prospective residents make informed decisions about their admission to this home. But there also need to be versions readily available for relatives or agencies representing prospective residents; and to enable the Commission to judge the scope of information available. 3. The registered person can demonstrate the home’s capacity to meet the assessed needs of current residents; but MCCH needs to be more responsive to changing or emerging needs. 5. Each placement is confirmed by a shared tenancy agreement governing the landlord / tenant arrangements. But work needs to be done by MCCH to produce a complementary agreement to obtain full compliance with the elements of this standard. EVIDENCE: Information The home maintains weighty master copies of its Statement of Purpose / Service User Guide source material, the contents of which can be extracted and copied as required. But there needs to be an abridged version of each (as intended by the National Minimum Standards – hereafter referred to as the NMS) for relatives or agencies representing prospective residents and for inspection purposes, so their level of compliance with the elements of the NMS can be readily assessed. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 9 Copies of an adapted Statement of Purpose and Service User Guide (intended for people with learning disabilities) were supplied for inspection, which usefully outlined a number of services and care principles – though the scope of each was not exhaustive when assessed against the NMS. Both documents were produced in easy read text (i.e. large font size, uncomplicated style and plain language) and illustrated with photographs or diagrams / symbols. The inspector understands one resident is able to read text, but staff look for opportunities to explain the detail to each resident as appropriate to their level of understanding. Admissions All four current residents were admitted long before the emergence of the Care Standards Act 2000 and the National Minimum Standards (the latest admission being in 1991). So this aspect of the service was not inspected on this occasion. The inspector was, however, shown some of the preparatory guidance produced for two residents who, for reasons of age and attendant mobility impairment, were transferred to more appropriate living arrangements. This was judged attentive to their needs and understanding. See, however, below for findings in respect of capacity to respond to changing or emerging needs. Capacity to meet the residents’ needs The home is generally able to demonstrate its capacity to meet the special needs of the current residents. Examples are detailed throughout this report. Records and anecdotal information confirm input from a range of specialist or healthcare professionals as appropriate. Examples include: Speech and Language therapy, psychology, Autism London, Occupational Therapy, and Community Psychiatric Nursing. None of the current residents has a mobility impairment. But there are grab rails on the front doors of both properties, and grab rails in the bathroom, which were introduced to assist former residents. One resident uses a boxstyle trolley and one former resident had a mobility car. There is a onehanded tin opener to facilitate its use by one resident in particular. One resident has “Objects of Reference” in a box (e.g. bowling ball) and to help him choose meals. Kent Association for the Blind came in to give guidance on how to make one resident’s environment more accessible and less distracting, and adaptations were made (see section on Environment for detail). He has a Talking Clock and also accesses Talking Magazines. See also section on “Lifestyle” for findings in respect of community presence. There is, however, some concern for the length of time it took to effect the transfer of two elderly residents onto more appropriate provision (something in excess of two years), which placed this home outside its registration category. MCCH needs to demonstrate a more ready response in future e.g. to one other resident’s emerging needs and aspirations to move onto more independent living arrangements. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 10 Contracts Each placement is confirmed by a shared tenancy agreement governing the landlord / tenant arrangements, which includes a number of elements prescribed by this standard – though its scope is not exhaustive when assessed against the elements of the NMS. This contract is not in a format/language appropriate to each resident’s needs, but the inspector understands that reasonable efforts have been made by staff to explain its terms to each resident. A separate arrangement for the care planning aspect of this home is assumed by clause 22, which refers to the tenant’s obligation to make use of the care and support and other services provided by the Association / Agent or other responsible agency. But there was no formal agreement available to document the detail. One would need to refer to each tenant’s Person Centred Plan to access action/activities identified to achieve their personal goals and lifestyle aspirations (NMS 5.2(vi)). In order to be fully compliant with the elements of this standard, there should be a formal documented agreement committing MCCH and the residents to specified arrangements for reviewing their needs and progress, and for updating the Service User Plan (NMS 5.2(vii)). And this document should identify those elements of the Care Management Care Plan (where applicable), which are to be provided outside of the home (NMS 5.2(viii)). Work should be done to make each contract available in a format/language appropriate to each resident’s needs, so that they understand as far as is practicable the terms of their placement there. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 11 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 6. Each resident has a Person Centred Plan, to meet their needs and aspirations. 7. The current residents were observed being supported in the daily routines, and observed interactions between staff and the residents were appropriately familiar and respectful during this inspection. 8. The current residents have a number of opportunities to influence their daily routines, and their responses are used to gauge their level of personal choice. 9. There are risk assessments to cover the residents as individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information is generally satisfactory. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 12 EVIDENCE: The format of the care plans is a comprehensive person-centred one, clearly designed to address the health and social care needs of the residents. The introduction of “Objects of Reference” for one resident with special communication needs (i.e. key objects that represent activities or choices available to him) has been of particular benefit. There was good evidence of the home summarising and keeping track of emerging trends through its key working system, monthly one-to-one sessions with residents and reviews, supervision sessions and team meetings. And there is a range of reporting systems: charts, logs and timetables for activities, behaviour, personal and healthcare needs. And the inspector also saw practical guidelines on behaviour management. These are all used to top up the more formal care planning documentation. There was good evidence of risk assessments in respect of each resident, their activities and the environments they use, on and off site. Confidentiality The home keeps hard copy and password-protected electronic records. Cabinets, computers, medication and office facilities are all properly secured. Each resident has a lockable facility to store money and valuables in, though these are portable and need, therefore, to be secured against firm surfaces as a precaution against their theft. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 13 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): 11, 12, 13, 14, 15, 16, 17 11. Residents have opportunities to learn and use practical life skills. 12, 14. Residents have their own routines but are also offered opportunities to experience new activities on and off site. 13. The home maintains information about local community resources and supports residents to use local public transport as well as the home’s own dedicated transport. 15. Families and friends are welcomed, and their involvement in the care planning processes is encouraged 16. The daily routines promote choice and independence, subject to risk assessments 17. Residents are offered a choice of suitable menus to suit their dietary needs and preferences, and are supported to plan and prepare or serve meals. Residents can choose where and when to eat. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 14 EVIDENCE: Abilities, activities and personal preferences are identified by the care planning process and subject to day-to-day consultation and reassessment thereon. The home maintains an activities folder and scans local papers for events which may be of interest. There is a weekly planner for each resident but it is applied flexibly. The home maintains records of activities undertaken by each individual, and daily reports on their mood, behaviour and level of interest. Residents were observed being supported to make decisions and choices during the inspection visit. This home also offers support to residents in maintaining their practical life skills (use of the kitchen as well as self care abilities), and this is underpinned by a comprehensive range of risk assessments and specialist input as appropriate. One resident already manages her day-to- day finances, and there are plans to support her to more onto more independent living arrangements. Two residents do voluntary work (keeping the site tidy at Reculver) and one is paid for the work she does as a disc jockey. Activities and Community Presence There is a dedicated vehicle but residents are also supported to use public transport (buses, trains) and to walk. There is a bus stop at the corner of the street, and buses come every twenty minutes. The home is 25 minutes walk into Canterbury City centre, with all the community resources and transport links that implies. The neighbourhood is said to be really friendly. The home receives Christmas cards from neighbours and some pop in. There are recreational activities both on and off site, and opportunities to access local resources such as shops, seafront, cafes and pubs, swimming, musical events, bowling, horse riding i.e. mainstream community activities not confined to or identifiable with disabilities. This list is not exhaustive. There was anecdotal information about the media work training provided by a music and arts group, where residents have been learning how to make presentations and backdrops, play instruments and put on shows. They also participated in the Arts Festival in Canterbury. The home also benefits from MCCH’s Visiting People Team which provides support workers to a group of homes, to help support residents with their activities. This is a home, where as one member of staff observed “we often say their social lives are better than our own!” Religious Observance None of the current residents goes to church, but the home uses Prospects (which is Christian Voluntary Organisation which values and supports people with learning disabilities). The master copy of the Statement of Purpose has extracts from the yellow pages and there is also information on local Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 15 resources, which has been pulled off the Internet. This is judged an inclusive approach. Contact with Families and Friends There are open visiting arrangements, and there was anecdotal information on the extent to which staff support residents to maintain family links and friendships inside and outside the home. Feedback from relatives, visitors confirmed that they were always made welcome. There is a cordless telephone line for the residents’ use. Catering Dietary needs and preferences are also established as part of the care planning process, and confirmed by day-to-day consultation. There was anecdotal information to confirm that individual needs and preferences were being catered for and about the extent to which they participate in shopping and the preparation of meals. The residents can have their meals whenever they want and this flexibility was observed on the day of this inspection. The home is at the same time committed to healthy living and one resident was said to have achieved his ideal weight for his height. A fresh fruit platter was observed, and this was said to be standard provision. The dining area is a congenial setting and staff eat with the residents. This is judged a good quality assurance tool. Records are kept of options actually chosen by individuals, as required. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 16 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 18. Residents have choice and control over most aspects of the personal and healthcare they receive, and the environment provides facilities for privacy. 19. The home ensures that the healthcare needs of residents are properly addressed. 20. The home has generally satisfactory arrangements for the management of the residents’ medication, within a risk management framework. Two matters were raised for attention. EVIDENCE: Personal Care The home’s care planning and risk assessment processes assess the extent to which each resident requires assistance with their own personal care, and their choice and control is actively promoted by staff as far as possible. All the bedrooms are single occupancy and there are enough toilet and personal care facilities to generally guarantee their availability and privacy. Staff are available on a 24 hour basis to assist residents. Healthcare Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 17 The care planning process routinely addresses a range of standard healthcare needs e.g. GP, optician etc. Records have been set up on file to document access to a range of other healthcare professionals as appropriate All four residents have the same GP practice, which has demonstrated specialist knowledge, so that the residents’ healthcare needs can be properly met. Medication The medication arrangements (Boots Monitored Doseage System) were inspected and judged generally satisfactory. The maintenance of information on the specific medication prescribed (including likely side effects), medical alerts and other advice along with risk assessments was judged good practice. And the home keeps a copy of the Royal Pharmaceutical Guidance to underpin knowledge and practice. However, staff need to ensure that the “allergies” section on Medication Administration Records is routinely addressed, and these records need to be better secured against loss and disarray. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 18 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 22. The manager and staff are attentive to the responses of the residents, and have managed conflicts and issues causing dissatisfaction effectively, particularly where there have been special communication needs. However, the complaints register needs to better reflect that. 23. MCCH have a policy for responding to suspicions or evidence of abuse, and staff showed a commitment to challenge and report any instances, should they occur. Less clear, however, was their understanding of the role of the CSCI EVIDENCE: MCCH has policies on complaints and whistle-bowing, but references to the Commission’s old title will require updating, and prospective complainants should have contact details for their local Commission office rather than its Head Office. There was only one complaint since the last inspection, which was on-going and judged effectively being managed. The absence of recorded complaints is not judged a realistic reflection of day-to-day life, given the special needs and interactions of the residents. It is accepted that a lot of work has been done to manage conflicts between them (e.g. behaviour intervention guidelines, reconfiguration of communal areas) and issues causing their discontent - the challenge will be to find ways of translating expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can evaluate the extent to which their responses are listened to and acted on. One resident has been accessing Canterbury Advocacy Service, and another resident’s name has been put on its waiting list. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 19 Meetings with staff confirmed their commitment to challenge and report any instances of adult abuse, should they occur. Less clear, however, was their understanding of the role and powers of the CSCI. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 20 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, 25, 26, 27, 28, 29, 30 24, 25, 28. The standard of the property is good. The furniture is domestic in style, and comfortable. Residents have a choice of communal areas, and there are homely touches throughout. 26. Residents’ bedrooms are well maintained and personalised, and where they don’t have all the furniture or fittings prescribed by the National National Standards this is justified. 27. Each bedroom has a wash hand basin, and there are sufficient communal bath and WC facilities to guarantee their availability and privacy. 29. The home is not wheelchair accessible but has ample useable floor space throughout. The garden area is spacious and interesting. 30. The home is well maintained, clean and free of offensive odours. EVIDENCE: The location (access to Canterbury) and layout of this home are generally suitable for its registered purpose. The furniture tends to be domestic in style and there were homely touches (including one resident’s artwork) throughout. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 21 The grounds are well maintained and there are focal areas in the back garden to draw the attention to, and a timber summer house to sit in. The home has a “No Smoking” policy – none of the residents smoke but staff are required to take their smoking breaks outside. Communal Areas The communal areas of this home are spacious. Most windows offer pleasant views of the gardens. The seating in the dining and lounge areas is appropriate for the residents who use them. The kitchen is light, airy, clean and well maintained. Three matters were raised for attention (see schedules). Communal Bathrooms / WCs There is a communal bathroom / WC on the ground floor of No.89 and a communal shower / WC on the ground floor of No. 81 plus a communal WC on the first floor of each property i.e. reasonably accessible to bedrooms and communal areas. The bathroom in No. 89 was judged in need of a deep clean along seams. Bedrooms All the bedrooms in this home are single occupancy. With one exception, all the bedrooms were inspected and found to be well maintained. In terms of their furniture and fittings, where they did not fully comply with the provisions of the National Minimum Standards, their non-provision was justified. Each bedroom was personalised. Four matters were raised for attention (see schedules). Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 22 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): 31, 32, 33, 35, 36 31. MCCH has a range of systems in place to ensure the proper co-ordination of roles, policies, procedures and care planning to benefit the residents. 32, 35. Records and information from staff indicate a sound investment in training and development, and Avenues has exceeded the requisite level of NVQ accreditation of staff. 33. The numbers and skill mix of staff on duty is determined by the assessed needs of the residents 36. Staff receive support and supervision to carry out their jobs. EVIDENCE: The following staffing arrangements apply to this home. • • • 8.30am – 4.00pm. Two staff, including a sleep-in staff who continues to work until 1.00pm) 1.00pm – 8.30pm. Two staff The sleep-in staff works from 2.00 – 10.30pm) There was compliance with this arrangement as described on the day of this inspection. The four weeks’ rotas supplied were not, however, inspected for Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 23 compliance on this occasion, for want of a legend to explain the codes used. This will be required in future. While, numerically speaking, this was judged an appropriate level of staffing, in the light of information on the assessed needs of the residents, the inspector was concerned to learn that the manager’s own hours are included in this arrangement i.e. that he isn’t generally operating in a super-numerary capacity. This is not judged an ideal arrangement, particularly as care staff, moreover, are tasked to do all the cooking and cleaning. Unless staff are actively supporting residents to do the cooking and cleaning, the inspector judged that this may not be as cost effective as employing ancillary staff, which would, thereby, free up staff for direct developmental / therapeutic work. MCCH should consider employing ancillary staff (even for a few hours each week or month) or require ancillary work to be separately detailed on staffing rotas – so that staff member’s scope to provide residents with one-to-one attention can be monitored. It is accepted that the MCCH provides the home with 20 hours a week supplementary support from its Visiting People Team. Key worker sessions are used to evaluate the effectiveness of the care planning process and the relationship between the key worker and resident and issues requiring wider or further attention are referred to the team and/or line manager appropriately Staff confirmed that they had supervision sessions, usually monthly (though records indicate there are lapses of up to three months), and that these sessions covered all those elements prescribed by the standard: specifically, the translation of the home’s philosophy and aims into work with individuals; monitoring or work with individual service users; support and professional guidance; and the identification of training and development needs. Records confirmed information obtained from staff i.e. that there is a satisfactory level of investment. 50 of this staff group are reported to be accredited to NVQ Level 2 or above. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 24 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, 38, 39, 41, 42 37, 38. The registered manager is qualified, competent and experienced to run this home according to its stated aims and objectives. He has an accessible and facilitative management style, which has encouraged positive achievement among staff and residents. 39. Quality assurance and quality monitoring systems are in place to measure the home’s effectiveness. 41. Records required by regulation for the protection of residents and for the effective running of the home are properly maintained. 42. The registered manager ensures as far as is reasonably practicable the health, safety and welfare of residents and staff. EVIDENCE: The registered manager has at least four years significant management and supervisory experience and currently waiting for his Registered Managers’ Award accreditation. He reported being well invested in by MCCH and his Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 25 readiness to be available for advice, support and his motivational skills were singled out as strengths. Feedback from one relative was judged representative – “I am extremely happy with the care my brother receives at the home. Alan Jones and his team are a credit to their profession”. The processes for managing the home are generally accessible, transparent and there are clear lines of accountability within MCCH. The organisation as a whole maintains a proactive overview of organisational issues. MCCH produced an Implementation Manual, listing 18 goals based on its Modernisation Strategy Document “Creating Community” which was based on staff conferences in October and November 2002. Each house was then set goals which it was tasked to provide implementation plans and to report back on progress. This is judged an inclusive approach. MCCH also has a proactive approach to quality assurance which places its stakeholders at the centre. See section on “Individual Needs and Choices” for details on the way this principle is being applied on a daily basis, and there been satisfaction questionnaires. There is no involvement of residents in policy development at a local level as yet but the inspector was advised that the MCCH is looking to get residents involved in the Board in some way. An advert and pro-rata rates were offered. The home’s last staff recruitment event was over two years ago. The inspector was advised that no residents wanted to be involved in that process. MCCH has a range of policies governing health and safety matters, which are underpinned by a robust level of investment in training. Staff are required to sign checklists as evidence of their compliance with health and safety related ones. All maintenance records seen were up to date and systematically stored. The home has the requisite insurance cover arrangements. Both copies of the home’s registration certificate will, however, need to be displayed. Less clear, however, was MCCH’s compliance with its duty to make its own formal, documented unannounced inspection visits at least once a month, to comply with all the provisions of Regulation 26 , for want of available records on site. This was judged a major shortfall, warranting an Immediate Reguirement Notice to be issued The residents are all white British and comprise two males and two females. The staff group (which has been very stable for some time) is also predominantly white British but shows an appropriate gender split as well as some cultural diversity – indicating a commitment to Equal Opportunities in the organisation. Access to activities not necessarily confined to this client group and community presence are central features of the care planning processes and have been reported on elsewhere in this report. Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 26 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 2 2 X 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 4 x 3 3 X Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 27 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. 1 Standard YA1 Regulation 4, 5 Requirement Timescale for action 30/04/06 2 YA20 Schedule 3(i) 3 YA22 22 4 YA26 23 Abridged copies of the home’s Statement of Purpose and Service User Guide (i.e. as intended for relatives or agencies representing prospective residents) must be made available for inspection, so their level of compliance with the elements of this National Minimum Standard can be assessed. Medication. The following 31/03/06 matters are raised for attention: - Staff need to ensure that the “allergies” section on Medication Administration Records is routinely addressed, and - these records need to be better secured against loss and disarray Complaints Procedures. 31/03/06 References to the Commission’s old title will require updating, and prospective complainants should have contact details for their local Commission office rather than its Head Office. Bedrooms. The following 30/06/06 matters were raised for attention: Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 28 • 5 YA30 16 6 YA41 26 One bedside light in No.91 was not working • One resident will require more than the NMS two double sockets. It is recommended that these are sited three feet above the floor to facilitate access • One bedroom in Room 89 requires a second comfortable chair unless non-provision can be justified by a properly documented consultation or risk assessment • Portable cash tins – need to be better secured Kitchen. The kitchen windows 30/06/06 should be fly proofed with screens when opened or there should be an insectocutor. MCCH needs to demonstrate 31/03/06 compliance with its duty to make its own formal, documented unannounced inspection visits at least once a month, to comply with all the provisions of Regulation 26 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 YA3 Good Practice Recommendations MCCH needs to demonstrate a more ready response in future e.g. to one other resident’s emerging needs and aspirations to move onto more independent living arrangements. Contract. In order to be fully compliant with the elements of this standard, there should be a formal documented agreement committing MCCH and the residents to specified arrangements for reviewing their needs and progress, and for updating the Service User Plan (NMS 5.2(vii)). DS0000023712.V276827.R01.S.doc Version 5.1 Page 29 2 YA5 Sycamore Heights 4 YA22 5 6 7 8 YA23 YA27 YA28 YA30 9 YA33 10 YA33 And this document should identify those elements of the Care Management Care Plan (where applicable), which are to be provided outside of the home (NMS 5.2(viii)). Work should be done to make each contract available in a format/language appropriate to each resident’s needs, so that they understand as far as is practicable the terms of their placement there. Complaints. The challenge will be to find ways of translating expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can evaluate the extent to which their responses are listened to and acted on. Staff need to understand the role and powers of the CSCI is adult protection matters, should they occur Bathroom 1st floor No. 89. Should be deep cleaned in seams The staff sleep-in room should be redecorated Kitchen. The following matters are raised for attention: • The Environmental Health Officer should be consulted over the minimum / maximum freezer temperatures allowable • The inspector would recommend a sample selection of 1st Aid equipment in kitchen for use in emergencies Staffing rotas should routinely include a legend to explain the codes used, so that anyone authorised to inspect them can evaluate staffing arrangements And they should separately detail any ancillary work being carried out e.g. cooking and cleaning MCCH should consider employing ancillary staff and redesignating the manager’s hours as super-numerary Sycamore Heights DS0000023712.V276827.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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