CARE HOME ADULTS 18-65
The Cherries 30 Julian Road Folkestone Kent CT19 HW Lead Inspector
Julie Sumner Unannounced 7th JULY 2005 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. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Cherries Address 30 Julian Road, Folkestone, Kent CT19 HW 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) 01303 259561 Parkcare Homes (No.2) Ltd Care Home 6 Category(ies) of LD 6 registration, with number of places The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd November 2004 Brief Description of the Service: The Cherries is registered to provide care and support for 6 young people with profound learning disabilities and complex needs. It is a large detached home with a spacious driveway in front and garden with patio at the back. All rooms are spacious and airy and all bedrooms are single. There is no lift or access for a person with physical disabilities. There is a high level of staff support to service users living in the Cherries with 3 of the current service users having one-to-one support. The home is situated close to Radnor Park, the town centre and Folkestone leisure centre. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection starting just before 12 o’clock and finishing at 3 pm. All service users were in the home but had been out during the morning at different times and were planning to go out in the afternoon. A new manager has been employed and has made an application to be the registered manager. The home continues to improve and develop the services provided to the service users. Service users are young and have moved on from home, schools and children’s placements. Staff are supporting current interests and also giving new and different opportunities for them to experience and discover what other activities they like. Service users need a lot of support to keep well and healthy and to be able to go out so have a high level of staff. During the inspection a range of methods were used to gather information including: being in the communal areas of the home and spending some time with staff and service users including eating lunch with them, discussion with acting manager and reading and discussing individual support plans, risk assessments, selected policies, statement of purpose, planned training and certificates. What the service does well:
Service user plans are well written and have utilised relevant information from their families. Families are involved with care and support as much as they wish to be. Staff spend time with service users giving them lots of positive attention and supporting them with different activities. Where it is indicated in the agreement between the home and the care managers for one-to-one support this is given consistently. All service users have full activity programmes. These are flexible but provide a structure as service users are still getting to know what they really like doing. Activities offered depend on past experience of what they like, responses to new opportunities and what is available in the local community. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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 The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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) 2 Assessments have been completed for all service users and give a good basis of current needs and abilities. EVIDENCE: The Company have produced an Outcome Based Assessment Tool that is used as the basis of the identification of needs and support required. Assessments have been viewed at previous inspections and were sampled as part of the service user plan. The manager is reassessing service users as needs change and individual experiences create new situations. The service user plan has been designed around this and also from further knowledge gained from getting to know individuals living in the home. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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 standard(s) 6, 7, 9 There are good service user plans and risk assessments that are designed to meet individual needs and develop independence and an increased understanding of the world in which they live. Service users communication skills are being supported to develop. EVIDENCE: Service user plans were viewed and also contained risk assessments. These were individually designed and included clear guidelines for staff to support service users with ongoing health conditions, social skills and personal care. Service users are gradually being introduced to adult activities and some of the childhood activities are still supported while service users need the security of the familiar and supporting them to grow and develop out of them. One service user is unable to participate with the planned programme fully following an incident of unexpected challenging behaviour in the community. Following risk assessment it was agreed that two staff should always accompany him on activities outside the house, therefore it has been necessary to recruit to increase the staff team and until new staff have been employed the external activities are restricted. Revised guidelines have been
The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 10 produced appropriately. A recommendation has been made to ensure that the full activity programmes is resumed as soon as possible. The home are working with the speech and language therapist to produce communication aids to enhance individual ability to make everyday choices. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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) 13, 15, 17 Service users are supported to participate in a range of activities. Service users are provided with a healthy and varied meals. One service user with a nut allergy is protected from harm by well trained staff who ensure that food offered is nut free. EVIDENCE: All service users have full individually designed activity programmes utilising local facilities. Activities offered depend on past experience of what they like, responses to new opportunities and what is available in the local community. Activities include: horse riding, swimming in both the local pool and fun pool in another town, walks and going to the pub for a drink or a meal. Arts and crafts, foot spas, massage and reading stories are examples of activities that are carried out in the home. Service users go out and go home to their families. Staff and transport support has been arranged to enable as much contact as the service users and families want. Service users are able to participate in their preferred activities and may be supported by parents or staff and also jointly. Staff will take
The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 12 service users home and for visits to their families. The manager and staff carry this out sensitively to support all individuals in the home. One service user has a nut allergy. The manager and staff have been gathering further information to expand the variety of foods they are able to offer him. The main meal is in the middle of the day as this suits service users’ current lifestyle. Service users and staff were complimentary of the meal a member of staff prepared. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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) 19 Service users receive responsible support from staff with health conditions. The service users would be assured of immediate treatment for severe reaction to nut allergy if staff received training in adrenalin administration. EVIDENCE: Further allergy tests are being requested through the GP surgery to identify all known allergies for one service user with a nut allergy to enable the staff to be clear about what food can be offered at mealtimes to maintain his health and wellbeing without limiting his choices unnecessarily. Service users with medical conditions require full support from the staff team to manage them and training in some specific procedures has been undertaken. Training regarding the emergency procedure in the event of a severe allergic reaction has not as yet been ascertained. At present there are guidelines for staff and risk assessments in place and in the event of an emergency community health services would be contacted. A recommendation has been made to continue to pursue training in administration of adrenalin to
The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 14 enable staff to respond immediately and directly in the possible event of anaphylactic shock. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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) EVIDENCE: Not inspected at this time. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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) EVIDENCE: Not inspected at this time. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 17 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) 32, 33, 35 Service users are supported by well trained staff. The quality of support being given to service users may be compromised by some staff working long hours without sufficient break. EVIDENCE: Each service user has a key worker. Four staff have just completed NVQ 2. One staff has achieved NVQ 3. The home has achieved the target of 50 of the staff team having these qualifications. There is a training matrix with planned and completed training. Training planned for next month is: POVA/Adult Protection, first aid, moving and handling, and CPI/managing challenging behaviour. The duty rota was viewed and discussed. Some staff are working long shifts of around 12 hours, which they have said they prefer. The staff role is intense as service users have one to one contracts, their communication is limited or in some cases disruptive and they display some challenging behaviour. Staff support service users with all aspects of their daily life including personal care, health care, social activities, housework and meal preparation. It is a
The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 18 recommendation from this inspection that the length of shifts be reconsidered to shorter amounts of time with breaks to enable staff to be able to support individuals most effectively. (Refer to standard 33) The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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) 38, 42 The manager has a clear vision and direction for the home to continue to improve and develop the service. EVIDENCE: There is a new manager in post who is applying to become the registered manager in the home. In discussion and viewing revised policies and records it was evident that the manager has identified priorities in the home and has been addressing these. Risk assessments carried out by the manager revealed the need for increased security in and out of the home. Additional locks and latches have since been fitted. The home has a folder with all environmental risk assessments a sample of which were viewed and discussed. Risk assessments cover all eventualities as far as is reasonable and were well thought out. The building is well maintained
The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 20 a sample of servicing certificates were viewed and evidenced that the home has all required safety checks. Staff have attended mandatory training in health and safety, first aid, food hygiene, infection control and moving and handling and updates are ongoing. All accidents and incidents have been reported and recorded appropriately. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9
The Cherries Score 3 3 x 3 Standard No 24 25 26 27 28 29 30 Score x x x x x x x
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LIFESTYLES x
Score STAFFING Standard No 11 12 13 14 15 16 17 x x 2 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 3 x The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 13 19 33 37 Good Practice Recommendations To ensure that the full activity programme for one individual currently restricted is resumed as soon as possible. To continue to pursue training for staff in the administration of adrenalin and use of the epipen. The length of shift time needs to be reconsidered to shorter amounts of time with breaks to enable staff to be able to support individuals most effectively. The manager needs to be registered. The Cherries H56-H05 S50913 The Cherries V226731 070705 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 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
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