Inspection on 22/08/06 for The Goodwins

This inspection was carried out on 22nd August 2006.

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 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Goodwins 22/06/07

The Goodwins 04/01/06

The Goodwins 20/09/05

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 Goodwins 3 St Richards Road Deal Kent CT14 9JR Lead Inspector Jenny McGookin Unannounced Inspection 22nd August 2006 10:00 The Goodwins DS0000065342.V305408.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 Goodwins DS0000065342.V305408.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 Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Goodwins Address 3 St Richards Road Deal Kent CT14 9JR 01304 389149 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) CareTech Community Services (No.2) Ltd Mr Benjamin Young Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: The is a two-storey, detached property. It is currently owned and operated by Care Tech Community Services. The home is registered to provide residential care for up to eight persons at a time, aged from 18 years to 64 years, who have a learning disability. There is one ground floor bedroom but the rest are located on the 1st floor. All the bedrooms are single occupancy. There are three bathrooms, a large communal lounge, a small lounge area / sensory room, conservatory, dining room and a kitchen. There are some adaptations but the premises are not currently judged accessible for individuals with significant mobility impairment. There is a large enclosed garden to the rear of the property, which is supplied with garden furniture and equipment for activities, and it is well maintained. In terms of access and scope for community access, the home is located on the outskirts of the coastal town of Deal, with all the community and transport links that implies, and it is within five minutes walk of the nearest bus stop and railways station. The home has on site parking for four vehicles, including its own adapted minibus and there is unrestricted kerbside parking off site. There is a small back garden and patio area for the service users’ use. The current fees for the service at the time of the visit range from £1,249.42 £2,398.82 per week. Information on the home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. There is currently no e-mail address for this home. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to review findings on the last inspection (January 2006) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion. The inspection process took just under eight and a half hours, and involved meeting with the registered manager (who purposefully came on duty to assist with the inspection) and a visiting senior manager from Care Tech Community Services; a senior support worker, two support workers, the day care supervisor and chef. The inspection also involved a tour of the premises and a range of records. One resident’s file, representing the most recent admission, was selected for care tracking. Conversations with the residents were not possible, because of their level of learning disability, but interactions between staff and the residents were observed during the day. What the service does well: What has improved since the last inspection? There has been a timely response to requirements and regulations and key standards are met. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 6 This is a staff team, which feels better invested in, and supported on a day-today basis. The rapport between the manager, staff team and residents is appropriately familiar, relaxed and respectful. The staff team have been focussing quite a lot on individual activities, and accessing the community more. As the manager pointed out “everyone was doing what they thought was best but needed to pull back and look at each resident individually. They’ve gone from leaps and bounds since then”. 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 Goodwins DS0000065342.V305408.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 Goodwins DS0000065342.V305408.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): 2 2. There is a systematic preadmission assessment process, which identifies needs, preferences and interests. The home needs, however, to demonstrate its control over this process. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: With two exceptions, all the admissions to this home significantly predate the emergence of the National Minimum Standards i.e. by as much as 16-17 years. The inspector selected the most recent admission to assess this standard. The resident was referred to the home through the Care Management processes. Records confirm that she was admitted on the basis of a full assessment undertaken by her funding authority, and that the funding authority also supplied the initial care plan, which was confirmed by a review after the first six weeks of her admission and has been developed thereon by the home. It was not possible to assess the introductory / admission process on this occasion, for want of available documentation (e.g. documented preadmission visits, observational exercises, or information about the home or terms of residency in accessible formats). There was a Care Tech assessment but it was not dated. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 9 There was some anecdotal information about preadmission visits and a trial stay before the resident’s stay was confirmed by contract. But the home needs to be in a position to better evidence that it is taking a lead in this process. The resident’s care planning processes are usefully underpinned by a range of risk assessments. See next section for details. The Goodwins DS0000065342.V305408.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 6. The preadmission assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs. 7. Observed interactions between staff and the resident were respectful during this inspection. 9. There are risk assessments to cover the residents as individuals, their activities and their environment (inside and outside the home), to maximise their capacity to be independent. 10. The arrangements for the storage and disclosure of confidential information are generally satisfactory. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 11 Each resident has a care plan, generated (in the file selected for closer scrutiny) in the first instance from the Care Management Assessment/Care Plan and the home’s own assessment; and it is clearly designed to cover all aspects of their health and personal / social support needs. Each resident, moreover, has an allocated key worker. The care planning processes, when read in conjunction with supporting documentation, include pre-emptive interventions to manage aggressive behaviours; a range of therapeutic activities (e.g. sensory sessions, outings); structured routines and environments; and means of addressing the residents’ special communication needs (Makaton, Widgit, objects of reference) in daily routines and in one-to-one support (referred to as Talk Time sessions). Less clear, however, (and despite the fact some documents are written in the first person as if by the residents themselves) was the extent to which the residents owned this process, and how their contributions influenced their lifestyle thereon, as reflected in care planning documentation. The care plan for the resident selected on this occasion, was not available in any other format to facilitate her understanding (e.g. visual, graphic, simple printed English, or video). Monthly reviews were missing and the first six monthly review was almost due. The inspector found good evidence of risk assessments in respect of individuals, their activities and their environment (on and off site). Limitations on facilities, choice or human rights to prevent self-harm or self-neglect, or abuse or harm to others, are made only in the person’s best interest, consistent with the purpose of the service and the home’s duties and responsibilities under law. In each case, action is prescribed to minimise the risks and hazards identified. Records confirm that this process starts before their admission and is recorded in their care planning documentation. On the day of this site visit, residents were observed being supported by staff to make decisions. Staff enable the residents to take responsible risks, according to, within the context of their individual Plans. None of the residents has been judged able to manage their own finances. This function is managed by Care Tech’s Head Office. Records are kept of all incoming and outgoing payments, and are subject to auditing. None of the residents is judged able to leave the premises without staff, but the manager reports having a policy in place to respond promptly to unexplained absences by any of them. Confidentiality The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 12 The inspector was generally satisfied with the arrangements for keeping records, medication, valuables and money secure. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 13 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): 11,12,13,14,15,16,17 11, 16. Staff enable residents to maintain and develop social, emotional, communication and independent living skills. The daily routines promote choice and independence. 12. Staff support residents to take part in fulfilling activities. 13, 14. This home offers a range of activities inside and outside the home. Links with the community are good, and support and enrich the residents’ social opportunities. Activities are recorded. 15. There are open visiting arrangements, and the home is well placed for access to local community resources. 17. This home’s catering arrangements have been identified as one of its key strengths Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 14 Activities Employment and training may not be realistic prospects for these residents, given their level of learning disability but staff help them to take part in valued and fulfilling activities. One of the support workers has taken on the role of activities supervisor, to good effect. Examples of activities on site include reading sessions, foot spas, make up and manicures; baking / making drinks; make-Up / manicures; and table top games. The home has also converted its second lounge into a sensory room, and the inspector observed residents relaxing with its range of facilities. Activities off site include day care, outings in the home’s own adapted minibus or to London or France; picnics, trips to cafes/restaurants, pubs, bowling, swimming, shops and the seaside. A book of 50 walks in Kent is being followed and there has been a trip to a major theme park i.e. socially inclusive activities not readily associated with their disabilities. Each resident has a four-week planner but this is followed flexibly, and a recent development has been the introduction of charts to report back on the success of each activity. In each case the activities are underpinned by risk assessments. Religious Observance One resident attends a Roman Catholic Church in Deal. One other goes to a synagogue once a month in Margate. The inspector was advised that she had never been before she came to this home. “We phoned around and asked, and they made her very welcome”. No other residents are interested in religious pursuits.. Contact with families and friends, and Community Presence This home is judged well placed in terms of access to bus routes, train routes and shops as well as pubs, restaurants, cafes and all the community resources associated with Deal. The home also has access to its own minibus. The office phone is ostensibly available for use but none of the residents is able to make or receive calls. A couple of them have relatives who ring the home e.g. to arrange visits. The inspector was advised that staff sit with the residents to open their mail with them. Choice and Independence The inspector was satisfied with the scope of this home’s risk assessments. Residents can generally choose when to get up and go to bed, whether to go out or stay in – the home’s daily routines are organised around this, accepting some would have day centre or other commitments. None of the residents is judged able to manage key to their own bedroom or to the front door of the home, but they have unrestricted access to the communal areas home and rear garden. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 15 The extent to which the residents can get involved in housekeeping tasks (e.g. cooking, cleaning rooms and common areas, laundry, maintaining gardens) is subject to risk assessment and care planning. The home has a no smoking policy. Catering Dietary needs are properly identified as part of the admission process, and adjusted according to the ways the residents respond to the meals provided, on a day-to-day basis thereon. Careful records are kept of their intake and their reactions to what is presented to them. The chef has had no formal training since she took on this role, and there is no pre-prepared cycle of menus in operation. There aren’t currently any special dietary needs to be catered for and adapted crockery is not really warranted, other than plate guards. But the meals provided at this home have been identified as one of its key strengths. The inspector had lunch with the residents and staff on the day of this site visit and judged the meal well prepared and presented. The residents clearly enjoyed the meal and extra helpings were readily available to them. Staff generally eat with the residents and have the same food, which is judged a good quality assurance tool. Staff were sensitive to the residents’ choice whether to eat alone or with others. The mealtime was relaxed, unrushed. No residents needed to be fed artificially but they were assisted appropriately. Meal times are offered at least three times a day and are flexible. Breakfast is between 7-10am; lunch (the main meal of the day) is from 12-2pm; the evening meal is between 4-7pm and supper at any time after 7pm. A range of snacks and drinks are also available to the residents. The chef has a weekly shop and tops this up on a daily basis, with fresh produce. The meals are varied and cosmopolitan, and there is a plentiful supply of fresh fruit and salads available. The inspector judged the chef has good reason to take pride in the standard of her home cooking. Residents observe and can assist with some elements of the preparation of meals, subject to risk assessment. And they are able, with prompts, to lay the tables and collect up their plates and take them to the kitchen after their meals. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 16 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 18, 19, 20. The residents receive an appropriate level of support with their personal, emotional and healthcare needs. Personal care is offered in a way protect their privacy and dignity and promote their independence. 19, 20. The health needs of the residents are well met with evidence of access to a range of healthcare services. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Personal care and healthcare The funding authorities provide an initial assessment of needs and preferences as part of the admission process, and this is then subject the home’s own care planning processes. There were records and anecdotal information from staff confirming personalised routines in respect of the support given to residents and the extent to which they can self-care. The home has a key worker system, and the induction of new staff includes personal care issues. All the bedrooms are single occupancy, so service users can be assured of privacy. Staff are required to knock on bedroom doors and wait to be invited The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 17 in. None of the residents has been judged able to manage a bedroom door key or lockable facility, and in one or two cases their access to drawers and cabinets requires assistance by staff because of their compulsion to damage or jettison objects. This is all subject to risk assessments in each case. There was some evidence of communication aids e.g. signs and symbols in use (Makaton, Widgit, and some objects of reference) and the current residents also appeared to show some understanding of spoken English. There are some grab rails (e.g. on two baths) but the home is not otherwise adapted for people with significant mobility impairment. Although one resident is reported to be hearing impaired, no one requires a Loop system (for use with hearing aids). There are three residents with visual impairment – the inspector was advised that although Kent Association for the Blind carried out a visit last year, a report was still awaited. This should be followed up. All residents are supported to access relevant community health care services as is appropriate. Medication None of the residents has been judged able to self-medicate – this is subject to individual risk assessment in the first instance. Record keeping, daily checks and storage arrangements were judged generally satisfactory. The home has a copy of The Royal Pharmaceutical Society Guidance on medication as well as a copy of the British National Formulary for reference. And details about each residents’ medication is kept on their files. Six staff are reported to be trained to administer medication, but this aspect was not further assessed on this occasion. The inspector will want to see whether the training is accredited and competency tested. The manager is asked to advise on this matter. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 18 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 22. The company has a complaints procedure, but it was not available in accessible formats to meet the special needs of the residents. 23. Residents are generally safeguarded against abuse. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Complaints The home has a “Complaints and Compliments” file, which explains the process and commits the home to timeframes for resolving complaints. However, although it gives the Commission as an option at any stage, it still refers to the NCSC, and will require updating to take the Commission’s new title and contact details into account. Nor were there any versions of the complaints procedure in accessible formats to meet the needs of the residents. There were no complaints registered. This is not judged a realistic reflection of communal living. It is accepted that these residents have special communication needs, which would need to be catered for. But the manager should continue to look for opportunities to translate expressions of dissatisfaction into recordable events, so as to demonstrate that prospective complainants not only know how to complain (i.e. that there is an accessible procedure – one-to-one “Talk Time” sessions with them are judged promising) but can be assisted to do so e.g. by staff of through independent advocacy. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 19 Protection The inspector understands the home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets. Meetings with five staff confirmed their commitment to challenge and report any bad practice, should it occur. The rapport between staff and the current resident appeared appropriately familiar and respectful. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 20 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): 24,25,26,27,28,29,30 24, 28. The standard of the property is adequate. The furniture is domestic in style, and comfortable. Residents have a choice of communal areas, and there are homely touches throughout. 25, 26. The bedrooms do not have all the furniture or fittings prescribed by the National Minimum Standard, and access is in some cases restrictive, but non-provision and restrictions can be justified. 27. Each bedroom has a washbasin, and there are sufficient communal bath and WC facilities to guarantee their availability and, to some extent, privacy. 29. The home is not wheelchair accessible and although it has ample useable floor space throughout, it is not adapted for people with physical disabilities. 30. The home is adequately maintained, but not free of offensive odours. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Premises Fit for Purpose The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 21 Access to the home and to local amenities is judged satisfactory for the current service users – the home is about five minutes walk from a bus stop and train station, and is on the outskirts of Deal (with all the community resources and transport links that implies). There is parking space for up to four vehicles on site and unrestricted kerb-side parking off site. The residents benefit from access to the home’s own minibus. The premises were judged generally adequate for its stated purpose; accessible for the current service users, and safe. Cracks in walls in some areas have been independently assessed earlier in the year and are not attributed to subsidence or major defects. But some areas are shabby and will require redecorating. One room in particular required better continence management. The inspector was satisfied that the provision of communal furniture and fittings observed generally complied with most of the elements of the standards in this section. Although the property has in its past been extended and has had some adaptations made, it is not judged suitable for anyone with a significant mobility impairment. There is no level change from the pavement onto the garden path, but there is one step into the lobby and another over the threshold of the front door. There is a side gate, which was originally intended for use by wheelchair users to access the property (from the back) but this is not an ideal arrangement, and the inspector was assured that the two residents most likely to use a wheelchair are able to stand at the door while the chair is lifted through. There is keypad access to the front door, which is kept locked to prevent unauthorised access. None of the residents is judged able to leave the premises without staff. Bedrooms With one exception (ground floor) all the service users’ bedrooms are sited on the 1st floor. All the bedrooms are single occupancy, so that privacy is available. None of them has en-suite facilities. All the rooms were judged reasonably individualised. But the provision of furniture and fittings observed does not comply with all the elements of this standard. The inspector was advised that non-provision (e.g. two comfortable chairs, bedside lighting or cabinets, tables to sit at) had been properly justified in a “Behavioural Guidelines” document, which was drawn up in partnership with the relevant Care Managers. In three cases, moreover, because of the residents’ compulsion to damage or jettison objects, lockable facilities are kept locked and can only be accessed with staff. And in one case furniture has been secured to the floor. The inspector also noted that the taps in a hand basin in one room had been disconnected because of a risk of flooding. The reader is advised that this is acceptable if it can be justified by properly consulted risk assessments, but there were other concerns. One bed had very crude blocks to raise it. Three bedrooms had impervious flooring rather than carpets – and two of those still smelled very strongly of the adhesive used The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 22 (matter first raised by an inspection in September 2005). One bedroom has scuffed walls and one bedroom clearly required better continence management (matter first raised by an inspection in January this year). Toilet and Bathroom Facilities The inspector judged there were sufficient bath and toilet facilities for the number of service users and that they were accessible to bedrooms and communal facilities, though access is supervised. There are two WCs and a bathroom with a hand basin on the ground floor (as well as a dedicated staff WC). There are two bathrooms on the first floor, each of which also has a WC and hand basin. There is no separate shower facility but two of the baths have shower attachments, so residents have some element of choice. All the bedrooms, moreover, have washbasins to comply with this standard, although the taps in one have been disconnected because of a risk of flooding. The standard of provision was judged generally adequate, although the seat in one WC was badly damaged and misaligned with the toilet bowl and another clearly needed de-scaling. One cistern handle was stiff to operate. The inspector was concerned to find that the locks on some doors had been disabled, or in one case would not be openable from the outside in an emergency. One light was only operable from outside, and that external windows did not all have blinds or curtains to ensure privacy, all of which might prove unsettling in a mixed gender household. Communal Space The inspector judged there was sufficient choice of communal space to accommodate a choice of social and recreational activities. There is a spacious lounge room, a second lounge room (which also doubles as a sensory room), a conservatory and a separate dining area and kitchen. All these areas were judged generally compliant with the elements of this standard and, with the exception of the conservatory (which was in need of redecoration) adequately maintained. The dining room provides a congenial setting for meals. However, other areas are very worn and in need of refreshing. There is an enclosed garden at the rear of the property, which provides discrete areas for privacy and there are some positive focal features such as garden furniture, swing seats, a basketball net and a large collection of colourful balls. Hygiene The kitchen is judged well maintained, but there are other areas of the home, which are in need of attention and are not odour free. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 23 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, 34, 35, 36 32. The registered manager is working to ensure that staff have the competencies to meet the residents’ needs, and compliance with the National Minimum Standard in respect of the percentage of staff with NVQ 2 accreditation, or above. 33. The home has an effective staff team, with sufficient numbers and complementary skills to support residents’ assessed needs. 34. The registered person appears to operate a thorough recruitment procedure. 35. The registered manager is working to ensure there is investment in staff training and development. 36. Staff receive the support and supervision they need to carry out their job. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The inspector understands the staffing arrangements are as follows: The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 24 • • • • From 7.30am till 3.00pm there should be one senior support worker and four support workers From 2.30pm till 10.00am there should be one senior support worker and four support workers There is also what is called a “day care” shift from 10am till 5pm or 11am till 6pm, which is covered by one member of staff from Mondays to Fridays At night there should be two waking nights and one sleep in staff who is on call. This arrangement is subject to variation, within an overall budget set by the company. • • • On Tuesdays and Wednesdays there should be one senior and three support workers, because of input from a sensory session group (“Magic Moments” session) and day care. On the weekends there should be one senior support worker and five support workers. A sixth member of staff takes over responsibility for the cooking. Extra staff are brought in to cover when residents are taken on outings The manager works from 8.30am till 4pm four days a week (applied flexibly). There are no ancillary staff to do the cleaning – support workers do the cleaning with the residents. There are also dedicated admin shifts in the working week, which staff take in turns. Staff recruitment, training and support Meetings with staff confirmed a robust recruitment process in place, in line with previous inspection findings. But this standard could not be further assessed on this occasion because the manager did not have access to the personnel files and Care Tech Community Services has, with the agreement of the Commission, retained CRB records at its head office. The inspector understands, however, that one of the Commission’s own Business relationship Managers recently audited the records held at the head office and his findings are being disseminated to CSCI offices. All staff have to undergo the Learning Disability Award Framework (LDAF) – accredited training as part of their NVQ accreditation. However, only 47 of the staff have obtained NVQ2 or above, so the manager will need to submit an action plan to regain compliance with the National Minimum Standard. All staff are also expected to undertake core training (e.g. fire safety, health and Safety, Food Hygiene etc) though one of two staff said that some elements will require refresher training. And there was anecdotal information of some special interest training (e.g. Makaton). The inspector was particularly interested to read a letter from the manager of the Dover / Deal Community Learning Disability Team, following their meeting with this home’s manager in June 2006, and their observational visit to the The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 25 home in July. This initiative is seeking to reinforce the good practice staff were already observed demonstrating and enhancing their skills / new ideas. There was discussion about an “Active Support” training package and a meeting with the Activities Co-ordinator to discuss options, tools and reading materials. And follow up with a psychologist and a speech and language therapist was proposed. All of which is judged a very promising development, though it was judged too soon to reach a finding on this. Staff confirmed they had regular supervision meetings, every four weeks, which the reader is advised exceeds of the National Minimum Standards. See also next section on “ethos”. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 26 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, 38, 39, 40, 41, 42 37. The registered manager has a range of relevant qualifications and experience to run the home. 38. The management approach is open, positive and inclusive. 39. Effective quality assurance and quality monitoring systems are being introduced to measure the home’s effectiveness, but these need to interact with business planning processes. 40. There are systems in place to ensure practice complies with the home’s written policies and procedures 41. Records required by regulation for the protection of residents and for the effective running of the home are properly maintained. 42. The registered manager ensures as far as is reasonably practicable the health, safety and welfare of residents and staff. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 27 EVIDENCE: Manager’s Qualifications and Experience The manager has been registered by the Commission since November 2005, which means he would have had to demonstrate he had the relevant qualifications in place or in prospect, and the relevant experience. Diversity and Inclusion With one exception (who is European), all the service users are white UK. The staff group shows some diversity, but there are currently no inclusion issues. Although the home uses some Makaton, widget, signs and symbols, the service users also have some understanding of spoken English and staff can generally make themselves understood. Staff were observed to have an appropriately relaxed rapport with service users during the inspection; and appeared to be able to communicate effectively with them as well as support them to make choices and decisions. The home operates a key worker system. This is a mixed gender team, which reports working harmoniously and flexibly to meet the needs of service users. Operational Arrangements Care Tech Services offers clear lines of accountability. The inspector judged the processes for managing this home open and transparent, and judged the delegation of budgets and authority appropriate. The manager controls a lot of the home’s budgets, but does have to justify some aspects of the expenditure to Care Tech Services. The inspector examined a range of records required by regulation for the protection of service users and for the effective and efficient running of the business, and found them well maintained, up to date and accurate. The inspector was also generally satisfied with the arrangements for maintaining the health, safety and welfare of service users and staff. There are regular staff meetings and promising initiatives such as one-to-one “Talk Time” sessions and skills development work with the learning disabilities team, to enhance the operational standards. Information supplied as part of the site visit confirmed by staff showed that the manager delegates responsibilities for a range of key roles to staff, while maintaining an appropriate level of overview and leadership. Business Planning and Quality Assurance There was no business or development plan for 2006/07 or statement of audited accounts available for inspection. This is required The inspector found promising evidence of the home seeking independent feedback on the quality of the services it develops, which confirmed a sound level of satisfaction. However, there needs to be a unit-specific business plan, The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 28 linked to these quality assurance initiatives and corporate business planning and auditing arrangements, to obtain full compliance with this standard. The views of service users and other stakeholders will be crucial to the success of this. Policies and Procedures Pre-inspection information indicates that all the policies prescribed by the CSCI are in place, where they are relevant to this service. The inspector was satisfied that the home’s policies are readily accessible to staff and there is a system in place for staff to certify having read them (though this checklist requires dates). Although, theoretically, policies are also available to service users they are not currently adapted in a user-friendly format for the service users. This should be pursued, to encourage their ownership. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 29 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 2 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 3 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 3 3 2 3 3 3 X The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 YA11 Regulation Requirement Timescale for action 31/12/06 2 YA22 3 YA24 4 YA24 16(2)(m)13(1)(b) The registered manager needs to access more specialist in-put and interventions for the service users. Out-comes of the interventions/programmes of care need to be documented and implemented and outcomes recorded and reported on. (Outstanding requirement from the previous 2 inspections. Timescale of 31/11/05 not met) Revised timeframe – 30/04/06 Some progress made 22 There needs to be an accessible format for the company’s complaints procedure, to meet the needs of the residents 23(2) The manager needs to carry out a detailed audit of the premises, and submit an action plan detailing all the repairs / refurbishment required, and attendant timeframes 16(2)(k) One of the bedrooms at the DS0000065342.V305408.R01.S.doc 31/12/06 31/12/06 31/10/06 Page 31 The Goodwins Version 5.2 5 YA39 24,26 6 YA43 25 home has a distinct unpleasant odour. It needs to be ensured that the home is kept free from offensive odours. Original timeframe 30/04/06 New flooring but odour persists The registered manager needs to ensure that there is an annual development plan in place specifically for the home and that quality assurance systems are developed. Original timeframe – 30/04/06 Service Users are to benefit from competent and accountable management of the service and the inspector requires to see evidence of this when visiting the home. This is to be interpreted as a summary statement of audited accounts and financial plan. Original timeframe – 30/04/06 31/12/06 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 Refer to Standard YA1 Good Practice Recommendations The manager is asked to submit an up to date Statement of Purpose and service User Guide (including sample versions in accessible format) so that they can be assessed against the National Minimum Standard The manager needs to be able to evidence the admission process The manager is asked to submit an up to date contract (including a sample version in accessible format) so that DS0000065342.V305408.R01.S.doc Version 5.2 Page 32 2 3 YA4 YA5 The Goodwins 4 5 6 YA19 YA22 YA22 7 8 9 YA28 YA32 YA41 they can be assessed against the National Minimum Standard The manager should follow up last year’s visit by Kent Association for the Blind, to optimise provision for the residents The company’s complaints procedure should be updated to take the Commission’s latest change of title and contact details (Maidstone Office) into account The home needs to look for opportunities to translate expressions of dissatisfaction into recordable events, so as to demonstrate the effectiveness of its complaints procedures. The conservatory area in the home needs up grading to provide a pleasant and conducive area for service users to use and benefit from. The staff need to develop their specialist knowledge and skills to meet the needs of the individual service users. In the absence of the registered manager, there must be delegated authority to a named member of staff to access records for the inspector. The Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Kent and Medway Area Office 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 © 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 Goodwins DS0000065342.V305408.R01.S.doc Version 5.2 Page 34 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!