Inspection on 13/03/07 for The Old Pepper Pot House

This inspection was carried out on 13th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

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Southfields

Thorndene

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Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Old Pepper Pot House 89 South Terrace Littlehampton West Sussex BN17 5LJ Lead Inspector Mrs J Aston Unannounced Inspection 13th March 2007 9.30 The Old Pepper Pot House DS0000068140.V327461.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 Old Pepper Pot House DS0000068140.V327461.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 Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Pepper Pot House Address 89 South Terrace Littlehampton West Sussex BN17 5LJ 01903 201 201 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) Arundel Care Services Limited Post Vacant Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care to 6 people in the category of Learning Disability (E) to enable existing residents to continue to live in the home once they reach the age of 65. New registration Date of last inspection Brief Description of the Service: The Old Pepperpot House is a three storey house situated on the sea front of Littlehampton. It is within walking distance of sea front amenities and local shops and facilities. The accommodation consists of six single rooms, kitchen/diner, dining room and lounge. There is a small garden to the rear of the property. As the property is provided over three floors and there is no lift this home is only appropriate for those people with good mobility. The service provides support and personal care to service users with a learning disability. It aims to support service users to lead a stimulating lifestyle and to promote and maintain their independence. Arundel Care Services Ltd owns the service. The Responsible Individual acting on behalf of the organisation is Mrs Maureen Millar. A new manager Mrs Janice South, who is responsible for the day to day running of the home has been appointed but at the time of inspection had not been registered with the Commission for Social Care Inspection. Fees for the home range from £1150.00 to £1458.47 The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection is the first inspection for this service. This inspection is called a key inspection and will determine the frequency of inspections hereafter. Only the key standards determined by the Commission have been assessed during this inspection. A visit to the home took place on the 13th March 2007 and was an unannounced visit. Five hours were spent in the home. A tour of the premises was undertaken, two members of staff and the manager were spoken with and a sample of records was examined. Three residents were in the home during the visit and were seen and one was spoken with however this was limited due to their level of disability. After the inspection comment cards were sent to relatives and two care managers however only one was received in time to inform this inspection. What the service does well: What has improved since the last inspection? This is the first inspection of the service after registration. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 6 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 Old Pepper Pot House DS0000068140.V327461.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 Old Pepper Pot House DS0000068140.V327461.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. The organisations admission policies and procedures ensure that a prospective service user’s needs are assessed appropriately before admission to the home to ensure that the home has the capacity to meet those needs. EVIDENCE: This is a new registration and currently three service users have been admitted to the home. The organisation has a comprehensive admission policy and procedure in place for Registered Managers to follow to ensure that the needs of any prospective resident can be met. There was evidence from information in service users’ files that an initial assessment and a full need assessment had been undertaken for each service user prior to admission. Service users had visited the home on several occasions and stayed overnight in the home before admission. This ensures that the Manager of the home is sure that the service can meet an individuals needs before they move into the home. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. 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. Service users’ needs and wishes are recorded appropriately. Service users receive support and assistance from members of staff to make choices and decisions in their lives. Potential risks for residents in their daily lives are considered and minimised as far as possible. EVIDENCE: The needs of each service user and the support they require are recorded on a care plan. During the visit to the home all three care plans were examined. Each care plan stipulates clearly the different needs of each person and the action members of staff have to take to meet those needs. Guidelines are also written so that members of staff have sufficient information to know how to support each service user in each are of need. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 10 Due to the level of disability most residents require some support with making decisions or choices. Where their choice or wish is known it is recorded in their individual file. Members of staff spoken with explained how they offer choices to service users to make sure they have some involvement making decisions. It is recommended that the Manager obtain information about the requirements of the Mental Capacity Act that will come into effect in 2007. This will ensure that the home is acting appropriately on behalf of residents where decisions have to be made in their best interests. It was noted that the care plans had been reviewed within the home within the last six months. The resident’s key worker had also reviewed the care plans and the support required by each service user on a monthly basis. The monthly review is recorded on a monthly report sheet and kept in the resident’s file. The Manager and staff team support service users to keep safe through highlighting any potential risks from within the home and in the community. It was seen that potential risks had been assessed for each service user and recorded on a separate risk assessment for each risk. Members of staff had signed each risk assessment demonstrating that they have read and understood the information. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. 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 home provides a range of activities for service users that include leisure and educational activities where appropriate. Daily routines within the home take account of service users activities and wishes. The home has maintained good links and relationships with relatives. Service users are supported to maintain a healthy diet. EVIDENCE: Due to the service users level of disability work experience or activities are not appropriate. Through case tracking and from speaking with members of staff it was demonstrated that service users are supported to undertake a range of activities that include leisure and community activities. They are supported to visit pubs, restaurants and shops and to be involved in other community activities where appropriate. One service user attends a day centre twice a week. The home has a vehicle to transport service users. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 12 From the information gathered during the inspection it was noted that service users have been supported to maintain contact with family. There was evidence that one service user is supported to visit his family alternate weekends and to phone them regularly. Daily routines in the home are based around activities but can be flexible dependent upon a service users wishes or behaviour. It was noted during the visit to the home that service users are free to choose where they wish to spend their time when in the home. A sample of menus were provided with the pre-inspection questionnaire. The menus are varied and include a takeaway on one night a week as chosen by the service users. All meals are cooked and prepared by members of staff. Service users are involved where possible in the food shopping for the home. Special diets are catered for. Members of staff confirmed that the service users have a wide variety of food available to them and includes fresh fruit and vegetables. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. Service users personal care and health needs are met appropriately. The service operates effective and safe procedures in the administration of medication. EVIDENCE: From case tracking it was noted that care plans provide comprehensive information about how to support each service user with all aspects of personal care. New members of staff work through a six week induction programme that covers the areas of personal care, moving a person and infection control. This ensures they have the skills and right approach when supporting each service user. Each service user requires support with any health matter. Through case tracking it could be seen that health professionals are contacted as required and a record is kept of the advice given and treatment required. There was a recent consultation with a Consultant Psychiatrist in respect of a service user’s behaviour. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 14 There were clear records of the last health check up and dental, chiropody, optician and hearing checks. All service users had received an annual health check from their G.P and a health record book had been compiled. During the visit to the home the storage and handling of medication was examined. The Inspector found that all medication was stored appropriately. The records relating to the medication administered were in good order. From staff records it was demonstrated that members of staff had received training in the safe handling of medication. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. There are appropriate procedures for dealing with complaints. The Registered Manager ensures the staff team have awareness about signs of abuse and know how to report any allegations. Service users finances are managed appropriately. EVIDENCE: The Commission has not received any complaints in respect of this service. The pre-inspection questionnaire provided prior to the inspection states that no complaints about the service have been received by the home. There is a complaints policy and procedure in place and a copy of this is included in the service user guide that has been made available in an easy read format for service users. New members of staff cover the complaints procedure and how to recognise signs of abuse in the six week induction programme. There have been no safeguarding adults referrals in respect of this service. A relative or an outside advocate takes responsibility for the finances of all three service users under Power of Attorney. Members of staff support service users to manage small amounts of money on a daily basis in order to pay for activities and personal items. It was noted that all transactions are recorded and receipts kept. The records are monitored and audited by the Manager and as part of the Regulation 26 inspections. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 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. 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 standard of accommodation provided for service users is good and provides a safe environment. EVIDENCE: A tour of the premises was undertaken during the visit to the home. On the day of the visit the home was clean and hygienic and provided a comfortable environment for the residents. Documentation relating to safety checks in the home was examined which demonstrated that the regular safety checks within the home are up to date and regularly undertaken. Hot water is controlled to a set temperature to protect residents from scalding, window restrictors are in place to increase security and risk assessments have been undertaken to ensure safe working practices for members of staff. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 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 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 (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. The organisation operates a robust recruitment procedure. Training is planned and covers relevant topics suitable for the work staff are expected to perform. Staffing levels are appropriate for the needs of the service users. EVIDENCE: Training records were examined at the visit to the home. The records demonstrated that members of staff receive an appropriate induction in topics relevant to the service user’ needs. Members of staff spoken with confirmed that they had received this training. The full training programme has yet to start but is planned for the year and will start in March. Some members of staff have recently undertaken training in challenging behaviour and physical interventions. The recruitment procedures followed by the Registered Manager and organisation were appropriate and included Criminal Record checks. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 18 Members of staff spoken with confirmed the recruitment procedure and that all the necessary checks had been undertaken. The records kept were in good order. From examining staff rotas and from speaking with members of staff the Inspector ascertained that the staffing levels within the home allow for two members of staff on each shift plus a member of staff on a shift that covers the middle of the day. At night one member of staff sleeps in and one covers a waking night. The staffing levels were appropriate for the number of service users accommodated. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 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 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 (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. The home is well maintained and safe for service users. The safety of service users and members of staff is considered and risks minimised as far as possible. EVIDENCE: A new manager has been appointed. At the time of the visit to the home the Manager had not yet been registered with the Commission. A registration application will be submitted shortly. A quality assurance system is in place and provides an organisation service review. A quality assurance exercise is currently in progress and questionnaires have recently been sent out. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 20 This ensures that the home and organisation are consulting service users, staff and relatives about the quality of the service and making improvements where necessary. Training records examined demonstrated and members of staff spoken with confirmed that training in the Health & Safety topics: Moving & Handling, First Aid, Food Hygiene, Fire and Health & safety is undertaken as part of their induction programme. This is in house training so further more in depth training has been planned in these topics in the training programme. Records seen on the day of the inspection demonstrate that safety inspections have been undertaken on equipment and utility supplies and maintenance systems are in place to ensure the safety of residents. Risk assessments had been undertaken in respect of potential risks to staff or residents when using kitchen equipment for example and other hazards within the home. A current public liability insurance certificate was in place. The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 21 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 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. 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. Refer to Standard Good Practice Recommendations The Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 23 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 Old Pepper Pot House DS0000068140.V327461.R01.S.doc Version 5.2 Page 24 - 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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