Inspection on 04/01/06 for Tamarisk House

This inspection was carried out on 4th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tamarisk House 03/08/07

Tamarisk House 07/08/06

Tamarisk House 14/07/05

Tamarisk House 09/03/05

Tamarisk House 14/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Tamarisk House 26 Holt Road Horsford Norwich Norfolk NR10 3DD Lead Inspector Mrs Dorothy Binns Unannounced Inspection 4th January 2006 10:00 Tamarisk House DS0000027586.V276329.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 Tamarisk House DS0000027586.V276329.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. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tamarisk House Address 26 Holt Road Horsford Norwich Norfolk NR10 3DD 01603 890737 01603 890840 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) www.caremanagementgroup.com Care Management Group Limited Position Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three (3) people with Learning Disability may be accommodated. Date of last inspection 14th July 2005 Brief Description of the Service: Tamarisk is a care home providing personal care and accommodation for up to 3 younger adults with a learning disability. The service user may also have a physical disability. Care Management Group Limited, whose registered office is located in London, owns Tamarisk. The home is located in the village of Horsford and close to the city of Norwich. Local amenities, shops and pubs are also close by. The home consists of an adapted bungalow. All bedrooms offer single occupation. One of the bedrooms has en-suite facilities. There is ample communal space. Externally, there is a large rear garden with patio, lawns and furniture. This is easily accessible to all service users. Limited off-road parking is available at the front of the home. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection lasting two and a half hours. The manager was not on the premises and the senior staff on duty attended to the inspector. Some records and policies were examined and requirements made at the previous inspection were discussed. The service users were observed in the living room and a short tour was made of the premises. Only some of the standards were inspected and some of those only partially. The main aim of the inspection was to see how the home functioned on a normal day. What the service does well: What has improved since the last inspection? What they could do better: The financial records could be much better organised and transparent. It is not clear enough what is happening to service users’ money. This is in the process of being tackled but is taking a long time to put right. The training of staff should be given more emphasis with more staff benefiting from specialist training in learning disability and more staff studying for a national care qualification. Staff also need to be more supervised. More permanent staff should be recruited to avoid the use of agency staff. The Home would also benefit from having a system for reviewing their own standards and analysing what needs to be done to make the home better. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 6 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. Tamarisk House DS0000027586.V276329.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 Tamarisk House DS0000027586.V276329.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): 2 and 4 A full assessment is carried out on each service user before they are admitted to ensure they can be properly cared for. Before admission, service users have introductory visits to ensure they like the home. EVIDENCE: The files of the three service users were examined and all showed a full assessment of the person’s needs and abilities and went into detail about the behaviour, health and likes and dislikes of each person. Social workers and the learning disability service are involved in providing the information before admission but the home conducts a full assessment itself. There have been no recent admissions but staff reported that when some one is being considered for the home, they come for a meal and for a day and may come for a few days to see how they get on with the other service. Relatives and advocates are involved. Once admitted they are then on a three month trial period before a final decision is made. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 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 and 9 The assessed needs and personal goals and wishes of each service user are reflected in their individual plans ensuring staff know how best to support them. The finances of the service users are well looked after at a local level but there is no transparency in what benefits are collected and what happens to them. Service users are supported to make their own decisions but risk assessments are carried out in those areas where there might be a danger. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 10 EVIDENCE: The care plans of all three service users were inspected and showed that there were clear action plans in place in terms of assisting the service user. Based on a full assessment, there were detailed instructions to staff about how to care for the service users, where there might be difficulties and what particular areas to monitor. Behaviour, health, eating, activities, sleep patterns were all included giving a detailed portrait of the service user. This would be helpful to staff giving them plenty of information. Staff also write progress notes every day describing how the service user has been and what they have been doing. These are good detailed records. Service users need a lot of assistance to make decisions though staff confirmed that they were able to make choices in normal daily activities such as choosing food, what to wear, whether they wanted to go out. They do need help in organising and using their money and all three have help from staff. How this process was carried out was inspected. The finances looked after by the home are confined to what is sent by the local office each month. The original receipt of benefits and what happens to them is not documented in the home. What the records showed was the money received into the home on a service user’s behalf and how that money was spent. Receipts were in place for items bought and staff signed the record to show the money taken out of the fund. All three records were checked against the cash held and found to be correct. A visit was later made to the main office to check how the finances were administered on behalf of the three service users. There, evidence was found of the disability living allowances being paid into the bank for two people but personal allowances are held in yet another location. The deputy regional manager was available and said they were in the process of moving all the finances to one place. Personal allowances are however paid into a business account of the company and then distributed. One person did not have a bank account herself and her money was dealt with by head office in London. There have been numerous discussions with this organisation about the need for transparency in the administering of service users money and this has still not been achieved. It is acknowledged that banks are being cautious in the opening of new accounts and there are difficulties with appointees. However at the very least three things must happen. One is that each service user should have a financial profile saying what is received in benefits on a regular basis on their behalf and where that money goes. Secondly, any money banked on their behalf in a business account must allow them to receive interest and statements showing that must be available for inspection. Thirdly, it would greatly help if all records were held in one place, preferably where the service user lives. Records on the ground in the home were satisfactorily kept and there were no worries on that score. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 11 In terms of service users leading an independent lifestyle, they all need quite a lot of help and certain activities are risky. The care files showed that risk was assessed in a number of areas to ensure that the service user was safe. Risks in terms of behaviour and health needs eg choking were covered, and also whether there was a risk outside of the home or in a vehicle. One showed a risk assessment on the service user helping in the kitchen. All these assessments were reviewed regularly. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 and 17 Service users are not able to work though more training opportunities could be explored. Contact with family is encouraged and service users have good relationships with their family. Service users are offered good food and enjoy their meals. EVIDENCE: Service users are not able to work either in paid or voluntary positions because of their disabilities and so far have not been attending training courses. They do attend the skill centre owned by the same company and all three go two days a week. Staff said that discussions are taking place about college placements and it is recommended that opportunities are explored. Service users are encouraged to maintain family links and all have good contact with their families. One service user was home for Christmas and has regular holidays with the family. Another goes home for five days every month and another is in regular touch by phone and staff take her to visit her mother. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 13 Families also visit the home and staff understood the importance of their contact. The visiting policy is in the service users guide and encourages families to stay in touch. The menus for a six week period were examined and found to be varied and nutritious. A choice of menu was offered at each meal though there were a lot of sandwiches offered at lunchtimes. Staff assured the inspector that the service users chose this option themselves. Staff also said that most food was freshly prepared and little processed food was used. All service users eat a solid food diet though two are on a low fat diet. Service users were seen having their lunch with enjoyment. On the menu for the evening meal was sausages and mash and vegetables. Pudding was a choice of yoghurt, ice cream or cake. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service users are assisted with their personal care in private and staff take account of their individuality. Service users are not able to look after their own medication but are assisted by staff in an appropriate way. EVIDENCE: Service users are all mobile and need a varied amount of support in carrying out their personal care tasks. One can do most of her own personal care while another needs help with everything. All can get in and out of the bath without a hoist though one needs staff to help them. Service users are attended to in private in their single rooms and are able to have a bath every day if they wish. Routines are flexible with staff describing different bedtimes. Staff help service users to buy their own clothes and the views of relatives are taken into account in terms of how the service users should look. They have their own possessions in their bedrooms and can enjoy privacy if they wish. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 15 The medication records were checked and found to be completed satisfactorily. A monitored dosage system is used and tablets are delivered from the pharmacy every month. Tablets in the packs were checked against the record and were correct. Medication is appropriately locked up. All staff are trained in the use of rectal diazepam as epilepsy can be common. However epilepsy is not significant with these service users and staff have no current care plan for such medication. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users are not able to speak out about complaints though staff do monitor their wellbeing. Complaints procedures are in place to deal with written complaints from relatives or social workers. Service users are protected from abuse by the homes policies and staff training. EVIDENCE: The complaints procedure is in the service users guide and issued in pictorial form to the service users. However staff said they would probably not be able to complain officially and they made sure they monitored their mood and whether things were troubling them. Relatives sometimes spoke up on their behalf. A complaint record is kept showing what complaints have been received and actions taken. There have been no complaints since July 05 and none have reached the Commission. Policies dealing with the protection of vulnerable adults and the prevention of abuse were seen in the policies folder and staff confirmed that they had received training. An example was given where a staff member had blown the whistle on a situation where she felt service users were disadvantaged and this had been passed on to management. This demonstrated that staff were not holding back on speaking up and that their concerns were listened to. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Service users live in a homely and comfortable environment though safety could be improved. The home is clean and has satisfactory facilities to keep it hygienic. EVIDENCE: A quick tour was made of the premises. This is an extended bungalow all on one level and located in a residential street near the shops and facilities of the village. There is access to a garden which in summer is very pleasant. Each service user has their own bedroom. These are not very large but have been made cosy. The service users share communal facilities which are homely and comfortable. The premises are bright and cheerful and were pleasantly warm. There are no hoists as service users are mobile though there are rails in the corridor. The main danger in the home was the very hot radiators which were unguarded. There were no risk assessments in the care files about the radiators and some areas like the bathroom may be less safe than others. It is required that risk assessments are made and acted upon. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 18 The laundry was seen to contain a normal washing machine which has a high temperature wash and a tumble drier. Staff reported no great problem with continence and where pads are worn, these were appropriately disposed of in the yellow sacks. Staff have protective clothing and are aware of infection control measures. There was no unpleasant odour in the home and it was clean and comfortable. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 36 Service users are well served with staff who are experienced and committed but more training should be provided to increase their qualifications. Service users are well supported by the staff though fewer agency staff should be used. One to one supervision of staff is not currently in place and should be reinstated for the benefit of the service users. EVIDENCE: The staff files were not available but staff on duty said they had received the relevant training in food hygiene, moving and handling, adult abuse, medication and fire. They had not received any specialist learning disability or communication training and LDAF induction and foundation training should be encouraged to meet TOPSS standards. Staff did demonstrate a good knowledge of the service users however and understood their needs and wishes. However formal training has been lacking with none of the staff qualified in NVQ. This is failing to meet the standard of 50 trained by 2005. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 20 The rota for the week of the inspection showed there to be one staff on duty from 7am to 10.30am, two staff on duty from 10.30am to 6pm and one staff on duty the rest of the time. For the three service users accommodated this was reported by staff to be sufficient and they were able to cater for the needs of the service users. They said service users get up at different times and two can wash and dress themselves so there is no rush. During the day with two staff they can take service users out and share a car with another of the small homes. Both staff on duty were regular staff at this home and knew the service users well. Agency staff are used especially at weekends but recruitment is taking place. On balance the staffing was adequate and they were able to cater for the needs of the service users though it is hoped that agency staff will be less used in future. Staff files were not available but staff spoken to said that they had not received individual supervision sessions as yet. They were aware of staffing problems elsewhere which were affecting the manager’s time. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Self monitoring, review and further development are not part of a system for quality assurance. An effective system needs to be developed to ensure the best care for the service users. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 22 EVIDENCE: The management of this home is shared with four other small homes for 3 or 4 service users. Currently staffing problems in other homes are preventing the manager from fulfilling her duties. A recruitment drive is underway and some restructuring of staff is planned. The manager is not yet registered. All but one of these management standards have therefore not been inspected. However Standard 39 on quality assurance was inspected as in the future it will be expected for homes to monitor more closely how they are delivering the care in their own homes. There was no evidence of any quality control system in this home and staff confirmed they had not been asked for their views about the home nor asked to help service users express theirs. They were not aware of any action plans for improvements. The manager was not available and it was possible that more evidence was locked away. However staff were not aware of any system and no annual action plan has been seen in the past by this inspector. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 1 33 2 34 x 35 x 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 x 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 x x x 1 x x x x Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 24 Yes 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. 2 Standard YA36 YA7 Regulation 18(2) 20, 17 & Sch 2 13(4)© Requirement One to one supervision of staff should be provided. Previous timescale 31/08/05 not met The way the finances of the service users are administered must be transparent and accessible. The risk of burning from hot radiators must be assessed and remedial action taken where the risk is high. Training appropriate to the work they perform must be offered to the staff. A system for reviewing and improving the care in the home (a quality assurance system) must be in place. Timescale for action 31/03/06 31/03/06 3 YA24 31/01/06 4 5 YA33 YA39 18(1)© 24 (1) 31/03/06 31/03/06 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 YA12 Good Practice Recommendations It is recommended that opportunities are investigated for DS0000027586.V276329.R01.S.doc Version 5.1 Page 25 Tamarisk House 2. 3. YA24 YA35 the service users to attend outside facilities and training. Previously recommended in July 2005 It is recommended that radiators are guarded to prevent burning. It is recommended that more NVQ training is provided. Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Tamarisk House DS0000027586.V276329.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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