CARE HOME ADULTS 18-65
Symonds House 2 Lavender Fields Lucas Lane Hitchin SG5 2JB Lead Inspector
Louise Bushell Unannounced 21.07.05 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Symonds House Address 2 Lavender Fields Lucas Lane Hitchin Hertfordshire SG5 2JB 01462 452460 01462 440186 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Leonard Cheshire Margaret Hayman Care Home 20 Category(ies) of PD Physical disability - 20 registration, with number of places PD(E) Physical Disability - over 65 - 20 TI Terminally ill - 20 Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are none. Date of last inspection 24.03.05 Brief Description of the Service: Symonds House is a purpose built establishment providing specialist support and personal care to 20 service users. The building is situated in the heart of the residentrial area of Hitchin. Local amenities are accessible, with the town centre only a short drive away. Symonds House is a two storey property with the main living and residential areas all on the lower floor, the building has facilities for the provision of activities, with offices, staffing facilities and a training suite available on the first floor. The building is surrounded by landscaped gardens with all areas accessible for persons requiring wheelchair assistance. There is a large ar park to the front of the building providing ample parking for staff and visitors and the home vehicles. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an extremely positive inspection that took place mid morning to early afternoon. The main focus of the inspection was seeking the views from the service users living within Symonds House. The inspection focused on a small selection of the core standards. Substantial time was spent with service users seeking individual and group views of the home. What the service does well:
The home is a purpose built establishment, providing specialist support and personal care to twenty service users. The building is approximately 15 months old and has been constructed to ensure individual needs can be meet at all times. All service users rooms are large and have ensuite facilities. Overhead multi directional tracking is available in each room. The entire building is decorated tastefully and is well maintained throughout. Landscaped gardens surround the home, with all areas accessible to wheelchair users. Two activity coordinators are employed providing a total of 45 hours per week. The provision of activities within the home appears to be high with positive feedback from many of the service users. Activity plans are visible and displayed within the home, service users are encouraged to engage in activities with peer groups and also access services and groups outside of the home. A number of service users following a group discussion expressed that they are happy with the activities provided and the staff are extremely helpful and kind. One service user wished that the external group events could be more frequent but was content with once a week. On the day of the visit to the home, interviews were being conducted with the management of the home. It was pleasing to discover that service users are clearly involved in the interview process and their thoughts and opinions are actively sought in the recruitment and selection of staff within the home. One service user fedback how they feel the process is very useful and are pleased that they are encouraged and supported actively to make contributions to the home. The home has a detailed and structured Statement of Purpose and Service Users Guide in place. Following discussions with a service user who has recently moved to the home, it was established that the referrals, assessment and transitions policy into the home is very clear and concise. The service user feed back was that they felt the process was well managed and they were informed with relevant information at each stage of the process. The service user commented that at all stages they felt supported and the staff were very approachable and kind. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 6 Medication is managed within the home extremely well. There is a management process set up within the home for the sound supervision of all medication issues and ordering. A positive relationship is held with the pharmacist. 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. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 4 Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service users and the home to continuously review the individuals care package provided. Information provided to the service users about the home and its terms is suitable to meet their needs and therefore enables the service users to make an informed choice about where to live. EVIDENCE: A comprehensive Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The Statement contains information for the service user to make an informed choice about where to live. The content is suitable to meet individual needs. Full assessments of each service users needs and aspiration are made before the service user moves into the home. The assessments carried out within the home are continuously occurring supporting and monitoring individual progress and needs identified. Qualified and competent people complete the assessments. The home also receives and seeks external specialist support to meet the individual service users needs. The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. A contract is then drawn
Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 9 between the home and the service user. The contract includes the terms and conditions within the home and the rights of the service user. Following a discussion with a service user that has recently moved into the home it is clear that there is a comprehensive referrals process including trial visits to the home. The service user was able to describe the process fully and felt that at all stages he was informed and aware of the information. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Individual needs and choices within the home are being promoted to encourage and empower service user self-determination, participation and consultation. EVIDENCE: Following discussions with a number of service users residing in the home, it was determined that their individual and group views are sought at all times within the home. Service users confirmed that there are regular service user group meetings to discuss issues as they arose within the home. Service users confirmed that encouragement, support and advice is provided on an individual basis to empower service users to make decisions within their lives. On the day of the visit to the home, interviews were being conducted with the management of the home. It was pleasing to discover that service users are clearly involved in the interview process and their thoughts and opinions are actively sought in the recruitment and selection of staff within the home. One service user fedback how they feel the process is very useful and are pleased that they are encouraged and supported actively to make contributions to the home. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported. EVIDENCE: Service users have the opportunity for personal development within the home. Service users were discussing that many options are available to them within the home. All service users within the home access services within the community and were able to confirm that they were received effectively and through professional channels. All service users are supported in gathering relevant information regarding employment, further education, employment skills and benefit advice if required. Some service users have an activities plan on their care plan which they have agreed and signed. This is aimed at promoting motivation and user participation and integration into community living. All service users are encouraged and supported to maintain links to the local community. The home is central to the town centre and is within a residential area. The home values and seeks to reflect racial and cultural diversity of service users through the celebration of, and awareness of different cultures, religions and festivities.
Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 12 During the inspection staff and service users were observed to interact equally with one another. Routines within the home promote service user independence. Service uses are unrestricted in movement around the home. Two activity coordinators are employed. The provision of activities within the home appears to be high with positive feedback being sought from many of the service users engaged with. Activity plans are visible and displayed within the home, service users are encouraged to engage in activities with peer groups and also access services and groups outside of the home. A number of service users following a group discussion expressed that they are happy with the activities provided and the staff are extremely helpful and kind. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. The management of medication is effective within the home ensuring that service users are protected and supported in the process. EVIDENCE: All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Service users needs are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to all services users regarding general health issues. Service users confirmed that the care provided is tailored to their individual needs and choices and preferences are always supported within the home. There is an on site physiotherapy service which can provide physiotherapy services to all service users on site from Monday to Thursday. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 14 A robust policy and procedure is in place to support the safe administration, storage and receipt of medicines. The home manages medications within the home extremely well. There is a management process set up within the home for the sound supervision of all medication issues and ordering. A positive relationship is held with the pharmacist. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened to. EVIDENCE: A comprehensive complaints procedure is in place, which details that all complaints are responded to within 28 days. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. Feedback from service users determined that there complaints are listened to and appropriate actions are taken. Comments were received from the service users regarding the relationship they hold with the staff and how they feel listened to and supported within the home. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30 Each service users individual space within the home is extremely well decorated and maintained, reflecting individual choices and preferences. The home is presented extremely well, focusing on a homely welcoming environment for all service users. EVIDENCE: All resources and equipment is provided within the home in abundance ensuring specialist and individual needs are promoted and changing needs met at all times. Shared space both compliments and supplements service users individual space ensuring that individual space is tailored to personal style and taste. All service users bedrooms have ensuite facilities. The service users rooms are all opening onto the garden area which adds to the quality of environment available within the home. All bedrooms within the home are extremely well maintained and decorated. All service users are supported and empowered to decorate and personalise their individual rooms to their own taste and personalities. Staff should be commended for their efforts and support. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 17 Toilet and bathing facilities are available ensuring that choices and preferences can be met, and specialist equipment is available as per individual service user need. Each service user bedroom has overhead multi directional hoist to support with individual needs. The home was clean and hygienic throughout. A maintenance person is employed within the home and it is very well maintained. All areas were extremely well presented and clean. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not fully inspected on this occasion. EVIDENCE: Not fully inspected on this occasion. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 42 The home is well managed, thus ensuring that all service users are provided with a quality service individually tailored to meet needs, EVIDENCE: Feedback from service users spoken with determined that the home is well managed. Comments received were extremely positive regarding the running and the management of the home. Service users expressed that they felt their views were listened to and that the service was run in their best interests at all times. Many service users gave positive comments regarding the staff on duty and that they are very caring, friendly, kind and helpful. The manager of the home is currently completing the Registered Managers Award fast track route and anticipates completion in September. The management of the home promotes an open, consultative participative approach ensuring effective leadership and management of the home. During the inspection a number of door wedges were observed within the main front office area of the home. Following discussions with the manager it was
Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 20 determined that if the specific doors are required to be open for effective management within the home, then methods suitable and those recommended by the fire authority must be in place. There is one specific door surround within the home that is in need of repairing, the management of the home has already identified this and works are scheduled to be completed as soon as possible. Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Symonds House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 2 x I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 42 Regulation Requirement Timescale for action 30th september 2005 23(4)(c)(ii The registered manager must i) ensure that only methods recommended by the fire authority are used to hold open doors. Works must be completed on the fixing of a specified door frame. 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 None Good Practice Recommendations Symonds House I52_s58598 Symonds House v238409 210705 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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