Inspection on 22/11/06 for The Bungalow

This inspection was carried out on 22nd November 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

The Bungalow 13/07/07

The Bungalow 02/02/06

The Bungalow 30/06/05

The Bungalow 19/01/05

The Bungalow 15/06/04

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 The Bungalow 150a Crabble Hill Dover Kent CT17 0SE Lead Inspector Kim Rogers Unannounced Inspection 22nd November 2006 09:50 The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bungalow Address 150a Crabble Hill Dover Kent CT17 0SE 01304 825739 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) The Robinia Care Group Ltd Mrs Julie Ann Staveley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users are restricted to three (3) service users with learning disabilities between 18 and 65 years of age. Service users are restricted to One (1) service user LD/OP whose DOB is 13/04/1940. 2nd February 2006 Date of last inspection Brief Description of the Service: The Bungalow is run by Robinia Care and supports people with a learning disability. The Bungalow is registered to provide personal care and support to up to 3 adults between 18 and 65 who have a learning disability. The Bungalow is situated in the grounds of a larger Robinia home. Both homes are managed by the same registered manager but are inspected separately. The Bungalow is intended to provide support for more independently skilled service users and also for service users who benefit from living in a smaller home. It is also suitable for service users with some mobility difficulties but is not currently adapted for wheelchair use. The home is situated on the outskirts of Dover in a residential area near to amenities with easy access to the main bus route/train station to the town. The home also has the use of a car for shopping, outings or visits to the service users’ families. The fee for this home is approximately £92,000 per year. For more information about the fee please contact the Provider. Previous inspection reports are available from the Provider. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key site visit was unannounced and carried out by two inspectors over about 4 hours. The manager, Ms. Julie Stavely, service users and staff assisted in the process. Three people currently live at the home, and all gave some feedback. People were coming and going in and out of the house and were doing activities with the staff and independently during the visit. The inspectors had a tour of the home, and with permission, some bedrooms were seen. The inspectors spent time with service users as a group and in private, spoke to and observed staff and interviewed and observed the manager. Service users said they feel safe and they have enough to do. All service users have a key to their room and take part in the daily chores of the home. Some work was done before the visit including talking to and surveying care managers and service users. The manager supplied a pre inspection questionnaire, with details of domestic checks and various other data about the home. A selection of records about service users, and some other documents such as staff recruitment files was seen. What the service does well: What has improved since the last inspection? The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 6 A start has been made on developing individual health action plans and person centred plans. New radiator guards have been fitted to some radiators. 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. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Information about the home could be more accessible to service users. Service users cannot be sure their needs and aspirations will be assessed. EVIDENCE: The home has a statement of purpose, which is currently being reviewed. This should outline what services the home intends to provide and should outline the home’s aims. The home is currently trying to meet two distinctly different purposes, and is at conflict trying to meet service users needs. The inspectors discussed the need to make the purpose and aims of the home clear to current a prospective service users and stakeholders. The home has a service user guide issued to all service users. This has some pictures and photographs included. The small font size and picture size means this is not accessible to all service users. There were no pre admission assessment documents at the home for the inspectors to view. Therefore some important information about service users was missing from their service user plans. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Service users cannot be sure their personal goals will be supported. Risk taking is generally supported but there could be more emphasis on enabling people. Systems to improve and support communication need developing. EVIDENCE: Each service user has a service user plan, which is quite clinical. After reading these you do not get a feel for who the person is, where they are from and what life they want. Work has been started on person centred planning books but this is not fully implemented and supported. Service users would benefit from having support plans with a focus on self-development. Some of the wording by staff is child like and this was discussed with the manager. Although service users sign these plans they said they are not fully involved in the development and review process. Service users do not take part in writing daily reports about themselves even though they could. One service user said this was the staffs’ job and felt they would not be allowed to take part. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 10 Some goals that had been identified had not been effectively reviewed therefore personal goals had not been moved on with achievement going unrecognised. Some risk assessments need more emphasis on enabling rather then restricting and this was discussed with the manager. Staff should note the last time the risk occurred during the review process. The home has made referrals to support communication needs where necessary. In the meantime, systems should be developed to improve and promote communication. Staff said one service user changes their mind a lot so it is difficult to know when they mean what they say. Developing a communication passport with this person will increase and improve understanding of their communication needs. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area for service users is good. This judgement has been made using available evidence including a visit to the service. Service users have opportunities to access community facilities. Relationships are well supported. Service users take part in planning and preparing meals but could be more independent here. EVIDENCE: Each service user has an individual weekly planner. The inspectors discussed the need to make some planners more accessible to service users for example by using photographs and pictures. Service users said they have enough to do and have the opportunity to access a range of community facilities regularly. Some service users go out unsupported and this is risk assessed. As mentioned, this risk assessment should have more emphasis on enabling rather than restricting. There are some missed opportunities for more independent lifestyles for example planning towards jobs and paid employment. Some service users could be more involved in meal planning and preparation and budgeting. This was discussed with manager who has some ideas to improve. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 12 Relationships with friends and family are well supported. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area for service users is good. This judgement has been made using available evidence including a visit to the service. Service users personal and health care needs are met. Medication practice is safe. EVIDENCE: Personal care needs are recorded in service user plans. Basic health needs are well recorded. A start has been made on individual health assessments and health action plans. Some service users may be able to develop their own health action plans. Service users have access to a range of health care support services. There have been several visits made to hospital via A&E since the last inspection. Not all of these have been reported, as they should. The manager agreed to address this. Medication records were in order. Staff have had competency assessments in certain medication practices. There are clear guidelines in place for staff to follow. Stock control is good and storage adequate. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 14 The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Service users cannot be sure their behaviours will be understood and supported positively. Service users are confident their complaints will be listened to and acted on. EVIDENCE: The home has an adult protection and whistle blowing policy. Staff attend training in safeguarding vulnerable adults. Service users spoken to said they feel safe. Staff use physical intervention to manage some challenging behaviours. The pre inspection questionnaire noted 29 incidents of physical intervention since the last inspection. Some guidelines to manage behaviours were inconsistent with little evidence of service user involvement and agreement or consent. New behaviours were not mentioned and de-escalation strategies not explained. The lack of review and analysis means that behaviours continue and put service users at risk of harm. Staff need the skills to do this analysis and would benefit from Positive Behaviour Support training. The manager said the organisation are looking into this training for staff and looking to improve behaviour support planning. The standard requires that physical intervention be used in accordance with the guidance from the Department of Health. The manager must ensure that this is the case. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 16 Service users said they would know who to talk to if they were not happy about something. The complaints procedure could be improved to meet individual communication needs enabling all service users to disclose. There are some restrictions imposed on personal possessions without the necessary individual assessments and agreement. The inspectors discussed with the manager the need to use the least restrictive option in agreement with service users. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,30 Quality in this outcome area for service users is good. This judgement has been made using available evidence including a visit to the service. Service users live in a clean, well-maintained home. Service users are happy with their bedrooms. EVIDENCE: The house is situated down a driveway off the main road and has some off street parking. The home was clean on the day of the visit. Furnishings are of suitable quality. Service users said they were happy with their bedrooms. One service user commented that they would like to have a mirror in her bedroom. The bathroom/shower room is in need of attention and this was discussed with the manager. A second lock on the bathroom is the type that cannot be overridden, so is dangerous and should be removed. The manager agreed to address this. One service user was observed struggling to open her door with a standard key. Thought should be given to providing a more suitable locking device. Service users have access to all parts of the home. Hand washing facilities are sited where needed. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. Staff have mandatory training but would benefit from training in person centred planning and Positive Behaviour Support. Recruitment checks are made but potential risks must be assessed as part of that process. Staff left alone and in charge must be competent. EVIDENCE: The organisation has a training manager. Courses can be accessed through the training manager. Courses have an emphasis on health and safety rather than values and learning disability issues. Most staff are not trained in person centred planning or person centred active support. The manager said the organisation has recognised this and is seeking to address it. At present no staff competency assessments are carried out. Observation does not form part of the supervision or appraisal system. The manager said she plans to address this. A staff file was sampled. References were included and other recruitment checks. Issues around staff health were discussed, and should be appropriately risk assessed. Staff work sleep in shifts alone at the home. Half the 6 staff working sleep ins and left in charge are under 21 years. There is no contingency plan or risk The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 19 assessment in place to protect staff and service users. The manager said she would address this at once. The manager said service users meet staff when they attend a trial day after passing the interview process but are not fully involved in the selection of staff. This could be improved. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area for service users is adequate. This judgement has been made using available evidence including a visit to the service. The home is adequately run but lacks effective monitoring and audit. A quality assurance system needs to be developed to ensure service users views underpin the review and improvement of the home. Service users health and safety is protected. EVIDENCE: The manager has several years experience in working with people with a learning disability. The manager has obtained an NVQ qualification at level 3 and completed a ‘registered managers award’ at a local college. The manager has no specific qualification relating to the service users the home supports for example, learning disability, and mental health or challenging behaviour. No effective quality assurance system has been established. This means there was no evidence that service users views underpin the review and The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 21 development of the service and there are major shortfalls to this minimum standard. The manager is not receiving supervision in line with the standard. The monitoring and audit of the service needs to be more effective. Risk assessments relating to the environment need updating as does the fire risk assessment. Some hazardous substances are not stored as they should be and the manager agreed to address this. The pre inspection questionnaire stated that some staff are not first aid trained. The manager must address this as staff work on their own at times and must be competent. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 22 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 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 1 X X 3 X The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 23 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 YA2 Regulation 14 Requirement Assessments must be carried out and include a person’s aspirations. These assessments must be kept at the home. Standards 6, 7, 9, 18. Consult with service users (through person centred plans / communication systems) and improve service users opportunity for independence and fulfilment. The manager must ensure that individual guidelines to support challenging behaviours are in place, up to date, consistent and reviewed regularly. Service users consent must be sought for any interventions or restrictions. Any physical intervention but be used in accordance with the Department of Health guidance. Improve quality assurance processes seeking and taking note of the service users opinions. Staff left in charge must be competent and be over 21 unless a detailed risk assessment is carried out. DS0000023248.V312747.R01.S.doc Timescale for action 31/01/07 2 YA6 12,16 30/04/07 3 YA23 12,13 31/01/07 4 YA39 24 28/02/07 5 YA32 12,18 31/12/06 The Bungalow Version 5.2 Page 24 6 YA42 23 Declared health needs of staff must be assessed and supported. The homes’ fire risk assessment and environmental assessments must be reviewed. 31/12/06 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 2 Refer to Standard YA1 YA37 Good Practice Recommendations The Statement of Purpose and service users guide should be reviewed and updated and be accessible to service users. The manager and staff should have up to date training to support service users specific needs. This includes learning disabilities, challenging behaviour, person centred planning and Positive Behaviour Support. The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Bungalow DS0000023248.V312747.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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