Inspection on 10/07/07 for The Dell

This inspection was carried out on 10th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Dell 23/05/06

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 Dell Kithurst Close Southgate Crawley West Sussex RH11 8TD Lead Inspector Mr E McLeod Unannounced Inspection 10th July 2007 2:15 The Dell DS0000066068.V345469.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 Dell DS0000066068.V345469.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 Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dell Address Kithurst Close Southgate Crawley West Sussex RH11 8TD 01293 561234 P/F 01293 561234 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) Evesleigh Care Homes Limited (ILIACE Group) Post Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006 Brief Description of the Service: The Dell is a care home registered to accommodate up to four Service Users with learning disabilities. The Registered Provider is Evesleigh Care Homes Ltd and the Registered Manager’s post is currently vacant. The current weekly charge is between £1,350 and £2,201. This information was provided on the day of the inspection. Additional charges are made for personal items, such as toiletries, clothing, and hairdressing. The home is a detached property in a cul-de-sac. It is situated within the town of Crawley, which has community facilities and rail and bus links. Accommodation is provided over two floors. Each resident has their own bedroom, with a bedroom located on the ground floor, and the remaining three rooms on the first floor. On the ground floor there is a kitchen that includes a dining area and utility room. In addition there is a nice size living room that leads into a small multi-functional room. Outside, to the rear of the property there is decking and flowerbeds. The Service Users Guide and Statement of Purpose, which incorporates inspection reports, are both located at the home and are accessible to Service Users, staff, relatives and anyone else interested in the service. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess how well the care home is doing in meeting the key National Minimum Standards (NMS) and the Care Home Regulations 2001. The findings of this report are based on several different sources of evidence. One inspector undertook the inspection visit on the 10th July 2007, which lasted for approximately three and a half hours. It is our experience that people living in residential care do no wish to be referred to as “service users”, and prefer terms such as “people” or less commonly “residents”, and therefore the rest of the report shall reflect this. The Commission received an Annual Quality Assurance Assessment (AQAA) from the service prior to this. The AQAA provided further evidence of how the home is meeting the Key National Minimum Standards. The Commission for Social Care Inspection (CSCI) sent feedback forms to people living at The Dell prior to this site visit and comments from these forms are reflected in this report. We interviewed three people living at The Dell, and two members of staff. The inspector met residents in communal areas. We also observed preparations for an evening meal. Two sets of care plans were sampled, together with other records including accident reports, complaints records, and reports of the provider’s monthly visit. What the service does well: What has improved since the last inspection? The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 6 A more structured daily programme is provided for each person living at The Dell. There are now more safe arrangements for the administration of medicines. People are personalising their bedrooms more. 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 summary of this inspection report can be made available in other formats on request. The Dell DS0000066068.V345469.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 Dell DS0000066068.V345469.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are only admitted to the home on the basis of a full assessment undertaken by people competent to do so and involving the person applying for admission. Each person has an individual contract and statement of terms and conditions with the home. EVIDENCE: CSCI ‘have your say’ surveys were returned by all three people resident at The Dell. These indicated that people made a positive choice of moving into the home, and felt they had received enough information on the service to enable them to make a choice. Two sets of pre-admission assessments were sampled. These indicated that a full assessment of the person’s needs had been carried out before the person was admitted to the care home. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 9 Two contracts/ terms and conditions of residence for people living at The Dell were sampled, and these included information on the fees and the person’s rights and responsibilities. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The person’s assessed and changing needs and personal goals are being agreed with him or her and are reflected in his or her individual plan. People make decisions about their lives with assistance as needed. People are offered opportunities to participate in the day to day running of the home. People are supported to take risks as part of an independent lifestyle. EVIDENCE: Two sets of care plans were sampled, and these included good guidance for staff on how the person saw their needs and what their interests, wishes and preferences were. Risk assessments seen had been updated, and guidance on The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 11 the management of behaviours such as aggression, agitation and anxiety were provided where this was appropriate. Care plans sampled included records of care plan reviews, which were carried out, and the person’s involvement in the review. It was also noted where a relative had been involved in the review meeting. People living in the home indicated in the CSCI surveys they completed that they felt supported to make their own choices, and felt they were listened to and their wishes acted upon. Records of care reviews and key worker meetings sampled indicated that staff are respecting the person’s right to make decisions in their own lives. Our observations of interactions between staff and residents during our visit indicated that staff provide active encouragement which leads to people making their own decisions. People contribute to the running of the home through individual and group discussions, and tasks such as menu planning, holiday planning, and shopping trips. Examples were provided of how people are being enabled to take responsible risks, which is supported by risk management planning. Risk assessments are updated at least every six months. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Dell have an active lifestyle and opportunities for personal development. People are being supported to take up further education, and to participate in the local community. Staff support people to maintain family links and friendships inside and outside the home. The routines and management of the home are promoting the individual’s independence and freedom of movement, other than restrictions agreed in the individual plan. People are offered a healthy diet and enjoy their meals and mealtimes. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 13 EVIDENCE: People interviewed gave examples of day time and evening activities which they do which helps them maintain and develop their social, communication and independent living skills. These include college courses, and opportunities for social interaction in their local community. Care plans sampled and conversations with people living at The Dell indicated there is a range of social activities available in the home and in the community that people are supported to take part in. People gave examples of how they were being encouraged and supported to continue their interests, hobbies and friendships. Staff felt that one of the main improvements to the service in the past year has been a more structured daily programme for each person that better reflects their interests and wishes. People in the home are assisted to maintain contact with their relatives and friends by phone calls, visits and outings. One person has been helped to learn how to telephone a relative who lives abroad, and now does this independently. To give people an experience of different cultures, themed nights in the home are being considered. Menus are planned with people in the house for the week ahead. Alternative choices are also offered, based on each person’s dietary needs and preferences. Menus seen indicated that meals provided are varied and nutritious. On the day of the visit, a freshly prepared meal with fresh ingredients was being prepared. People interviewed said the meals were good. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal support in the way they prefer and require. The physical and emotional health needs of each person are being met. People are being protected by the policies and procedures in place for the storage and administration of medicines. EVIDENCE: Care plans sampled provide a lot of detail on the person’s wishes on how they wish to be communicated with and how they wish their care to be provided. Interactions observed between staff and people living at The Dell indicated that staff are providing sensitive and personal support and are seeking to maximise people’s privacy, dignity independence, and control over their own The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 15 lives. One example of this was the support people have received with individualising their bedrooms. Monthly residents’ meetings and monthly meetings between the individual and the key worker are held, and meeting records were sampled. There is an action plan at the end of each key work meeting record, and at the follow up meeting it is reviewed with the person which parts of the plan have been met or not met, and how things are to be taken forward. Staff interviewed said that relatives can attend key worker meetings if they wish, and some have done this. Staff interviewed said that community services such as advocacy support and services provided by the local learning disability team were being planned to better support the needs of each person as appropriate. Staff gave examples of how the social and emotional needs of people were being supported. Care records sampled indicate that people are accessing the health care services they are in need of. Staff said medication reviews take place every 3 or 4 months with the appropriate GP or psychiatrist, and people are offered an annual health check. A health action plan and a medical care summary sheet were provided in the care plans we sampled. A pharmacy inspection was undertaken on 19.10.06, and recommendations such as second signatures on MAR sheets and a weekly audit of medicines have now been implemented. Staff interviewed said that there had been no stick injuries since the previous inspection, and accident records sampled supported this view. . The Dell DS0000066068.V345469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and effective complaints procedure which people living at The Dell are aware of. People living at The Dell are safeguarded abuse, neglect and self harm. EVIDENCE: A complaints procedure is in place, and people living at The Dell told us in CSCI survey forms received that they knew how to complain and who to complain to if they needed to. The record of complaints was seen, and the one complaint recorded since the previous inspection was discussed with staff. This indicated that complaints are being dealt with promptly and fairly. One safeguarding adults referral has been made to the local authority since the previous inspection, the outcome of which was that no further investigation was deemed necessary by the local authority. Care plans sampled included guidance for staff on managing aggression, where appropriate, and an identity sheet should the person go missing which The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 17 included information that would be helpful to external agencies for when the person is found. A record of incidents is held on the care plan which advises how the person has been supported through incidents which have taken place. The provider advises that people are being encouraged to sign for their personal money. Records seen indicate that most staff are up to date with training in safeguarding adults. Staff also undertake training in dealing with aggression. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at The Dell live in a homely, comfortable and safe environment. The home lacks a planned maintenance and renewal programme for the fabric and decoration of the premises. Shared spaces complement and supplement the person’s individual room. The home is clean and hygienic. EVIDENCE: Improvements to the premises have included people personalising their bedrooms more. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 19 There are three main communal areas in the house, being the sitting room, the quiet room, and the dining room/ kitchen. The carpet in the sitting room is heavily stained, and staff advised that attempts to clean the stains have not been successful. There is a small garden, which includes a decked area for social use. Part of the fencing around the decking is in need of repair, and the shed roof is not waterproofed at present. Fencing on one side of the property has an open view of the garden of the adjoining house, and it may be that people living at The Dell would prefer an arrangement, which offers them more privacy. There are arrangements in place for maintenance work to be carried out by the company on the premises, and staff advised that the company were at present seeking to recruit maintenance staff. It was apparent during the visit that maintenance and renewal matters such as the sitting room carpet and the condition of the shed roof had been outstanding for a while, and it was unclear what timescale, if any, the company had set for attending to these matters. A homely environment is being provided for residents, and apart from shortfalls noted above, the home is in good decorative order and is furnished to a good standard. All areas of the home visited were clean and hygienic. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Dell are supported by competent and qualified staff. The home has an effective staff team with sufficient numbers and complementary skills to support the individual’s assessed needs at all times. People living at The Dell are supported and protected by the home’s recruitment policy and practices. There is a staff training and development programme which ensures staff fulfil the aims of the home and meet the changing needs of people living at The Dell. EVIDENCE: We were advised in the home’s annual quality assessment (AQAA) form that six full time and two part time staff are employed in the home. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 21 At the time of the previous inspection five staff had achieved the national vocational qualification in care (NVQ) at level 2 or above. We have been advised in the AQAA form that all eight staff now employed have the NVQ at level 2 or above. On the day of the inspection visit, the staff on duty were able to meet the needs of the people accommodated. Staff advised the inspector that one member of staff is on waking night duty, and another member of staff is on sleep-in duty. Staff interviewed advised us that staffing levels have been good enough to ensure that there has not been a need to employ agency staff during the past three months. Induction training for new staff is being provided. Staff training records were sampled, and these indicated that training in core topics such as manual handling, fire safety, first aid, and administration of medicines is being provided. The provider has advised us that all staff have had satisfactory preemployment checks. As there has been little change in the staff team since the previous inspection, and recruitment records were found at that visit to be satisfactory, no recruitment records were sampled during this visit. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been an unacceptable delay in putting forward an application to register as manager for The Dell a person who is suitably qualified, competent and experienced to run the home. The management approach of the home creates an open, positive and inclusive atmosphere for people living at The Dell and staff working there. The views of people living at The Dell are influencing how the service develops. The health, safety and welfare of people living at The Dell is being promoted and protected. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 23 EVIDENCE: There has been no manager registered for the service since May 2006. Staff advised the inspector that a manager has been running the home since June 2006, and that an application to register the manager has recently been submitted to CSCI. Staff felt that improvements to the service in the past year have been helped by having a good manager at The Dell. Staff interviewed said that the change of manager has led to a more relaxed atmosphere in the home, and to arrangements in the home being more based on the wishes of the people who live there. Staff said that the manager was found to be very approachable by staff and by people living at The Dell. The provider has advised us of the dates that required policies and procedures have been most recently updated, and when equipment services and checks have most recently been carried out. Regulation 26 visit reports were sampled for June 2007 and May 2007, which indicated that the provider has an improvement agenda with the home for the service provided and matters for action are recorded and followed up. Residents’ meetings are taking place, and their views on improving the service are being sought. The record of accidents was sampled, and appropriate action is being taken to promote the safety of people living at The Dell. No instances of needle stick injuries have been recorded since the previous inspection. Staff believed this was due to better staff awareness and clear arrangements for the disposal of used needles. All care staff have received training in safe food handling, and records were seen which indicated that the Safer Food system for recording food safety checks is in place. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 24 Fire safety records were sampled, and staff advised that regular safety checks in the home are carried out. Safety checks records for June and May 2007 were sampled. The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 25 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 X 5 3 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 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 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 3 3 X X 3 x The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 26 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 YA24 Regulation 23.2 (b) Requirement That the home have a planned maintenance and renewal programme for the fabric and decoration of the premises, with records kept. The registered provider shall appoint an individual to manage the care home where - (a) there is no Registered Manager in respect of the care home, and (b) the registered provider is an organisation or partnership. (previous timescale of 30.6.06 not met). Timescale for action 28/09/07 2. YA43 8(1) 28/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Dell DS0000066068.V345469.R01.S.doc Version 5.2 Page 28 - 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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