Inspection on 14/06/05 for The Old Rectory

This inspection was carried out on 14th June 2005.

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 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

The Old Rectory 27/03/07

The Old Rectory 27/10/05

The Old Rectory 24/09/04

The Old Rectory 25/05/04

The Old Rectory 11/01/04

The Old Rectory 29/09/03

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

CARE HOME ADULTS 18-65 The Old Rectory Singleton Chichester West Sussex PO18 0HF Lead Inspector Lynne ODonnell Unannounced Tuesday 14 June 2005, 10:00am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address Singleton, Chichester, West Sussex, PO18 0HF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 811482 Dignity Group Limited Mr Clive Lucas Care Home 27 Category(ies) of PC Care Home 27 registration, with number of places The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29 September 2004 Brief Description of the Service: The Old Rectory is registered to accommodate 27 Younger Adults with Learning Disabilities. The current registration allows current Service Users who reach the age of 65 to continue living at the home however, no Service User over the age of 65 can be admitted. The Old Rectory is set in extensive grounds and gardens within the quiet village of Singleton. The accommodation is split into four sections within two buildings, the Old Rectory, Rafters and the Garden Flat are within the main house. Segal House is a separate bungalow within the grounds which accommodates Service Users with more severe disabilities or challenging behaviour. The Old Rectory is owned by an organisation, the Dignity Group Ltd. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection which took place during one day with a short return visit on 20 June 2005. In preparation for the inspection, previous inspection reports were reviewed along with any other relevant correspondence held on file. During the Inspection nine residents were spoken with and three resident’s showed the inspector their rooms. Staff were spoken with both individually and together. General observations were made during the course of the inspection and a sports activity was observed in Segal House. In addition the care plans for seven residents were seen along with other related documentation. The atmosphere throughout the home during the inspection was observed to be calm and relaxed with those residents at home choosing what they wished to do and when. Residents were happy to speak with the Inspector about a variety of aspects of their lives at the home and the different educational and recreational activities they enjoy. For those residents unable to communicate with the inspector, staff were able to demonstrate the different activities these residents are supported to participate in, through records kept and photographs taken. Residents were observed to be relaxed with the staff team and responded well to them. Staff were knowledgeable of individual residents needs and how to meet these. It was evident that staff have worked hard to improve the opportunities available for residents, particularly in Segal House, and this has proved very beneficial for the residents living there. Throughout the whole home it was evident that progress has been made in care planning and risk management strategies. What the service does well: The staff team promote an individual approach to meeting the assessed needs of residents at the home. Care plans provide detailed information as to individual residents needs, with evidence of resident and relative input into the development of these. Staff support residents to be involved in the day-to-day running of the home. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 6 Relationships between staff and residents are positive and supportive. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 4 5 There is a Statement of Purpose in place which sets out the aims and objectives of the home, and outlines the services offered. This document has been given to current residents and is available for any potential residents and their representatives. Prospective residents and/or their representatives are able to visit the home prior to moving in. Each resident has a written contract detailing their terms and conditions. EVIDENCE: The Commission has been given a copy of the Statement of Purpose. Residents, if they chose to, keep a copy of the Statement of Purpose in their rooms. At the time of this inspection no new residents had moved into the home since the last inspection however staff are currently working with two potentially new residents. It was evident from discussion with staff and social workers that visit are made to both assess the potential resident and enable them to both visit and stay at the home prior to any final decision being made as to moving in on a permanent basis. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 7 8 9 All residents have an individual care plan in place, which provides full details regarding their personal, social and health care needs, which would assist and enable staff to ensure and monitor that these needs are met. Residents are supported to make decision about their lives with appropriate support from staff as necessary. Residents are enabled to participate in the day-to-day running of the home both on an individual and group basis. The homes risk management process has been greatly developed since the last inspection with individual risks identified and the action necessary to minimize risk recorded. EVIDENCE: A sample of care plans were inspected and these showed that detailed care plans are in place which cover all aspects of personal, social and health care needs. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 10 For residents who have specific or specialist requirements details as to how these are to be met are documented, along with any additional external support and guidance from other health professionals involved in their care. Some residents do display challenging behaviour and individualised procedures are in place as to how this is to be managed. It was evident that these follow guidelines advised by other health professionals as necessary. All residents have goals and objectives set. These are agreed six monthly through the homes review procedures. These reviews involve both residents, their family or other representatives, and other health care professionals as appropriate. The goals and objectives are reviewed on a monthly basis with progress towards and/or barriers preventing achievement noted. All residents have a named keyworker. Residents spoken with were able to identify their keyworker. Staff spoken with also demonstrated a good understanding of the role of keyworkers. All staff spoken with were knowledgeable and understanding of the individual needs and wishes of the residents. In addition to the care plans, the staff team have developed ‘matchstick’ profiles for all residents which summarise the needs of residents. These are held in a folder in the areas of the house in which the residents live. These are a useful tool for both new and agency staff as they provide all essential information in an easily accessible format. In Segal House an informative booklet has been produced by staff which includes information on the aims and objectives of the house, guidelines for working with residents, role of key worker and specific duties throughout the day. This would also be a useful tool for both new and agency staff. Significant progress was noted with the risk management process and risk assessments undertaken for individual residents, with a named member of staff taking the lead in this. It was evident through discussions with residents and staff, observations during the inspection and through records seen, that residents are supported by staff to make their own decisions about various aspects of their lives. Residents are also supported to manage their own finances within their capabilities to do so, with staff promoting money skills through independent living activities. On arriving at the home a staff meeting was taking place in one part of the home, at which residents were present. Minutes were also seen for a residents meeting held the previous day. Resident participation in day to day aspects of the home varies in accordance with capability to do so, however it was evident throughout the inspection that residents are supported to be involved both on an individual and group level. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 11 Staff are to be commended for the improvements and achievements made in their care planning systems and approach to meeting the individual needs of residents. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11 12 13 14 17 Staff enable and support residents to develop and maintain independent living skills both through opportunities at the home and through accessing external training courses. Residents are able to pursue their own hobbies and interests and are also supported to take advantage of other opportunities in both educational and leisure activities. Residents are enabled to make use of local services and facilities. Daily living routines are flexible and residents are encouraged to maintain as much independence as their capabilities allow. Residents are encouraged to participate in the setting of menus and aspects of meal preparation as far as they are able to do so. EVIDENCE: Through records seen and discussions with both residents and staff it was evident that residents have access to a number of opportunities both within the home and externally to learn, develop and use a variety of practical life The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 13 skills. Budget training is one activity that staff support residents in. Residents also spoke of a variety of training courses they have done at college. At the last inspection it was noted that opportunities within the home are sometimes limited due to the staff time available. Whilst there has been no change to the staffing numbers in the main house and staff felt that they would like to be able to have more time to promote independent living skills whilst residents were at home, this was not an issue raised by residents themselves at this inspection. Residents spoke of shopping trips to local towns, visits to coffee shops in the area and going out for meals, sports clubs, discos and many other social activities. The home does have transport available, however this is sometimes limited, both through availability of the vehicles and also through the availability of drivers. Weekly bus passes are now purchased for use by some residents. The cost of this is currently met by the residents. This was discussed with the Registered Manager who advised that this is in agreement with Social Workers and is covered by the mobility component of residents Disability Living Allowance. However the Registered Provider should ensure that transport provision and costs thereof are consistent with resident’s individual contracts and agreed care plan and day service activities. The range and frequency of activities for residents in Segal House has increased significantly since the last inspection and it was evident through observations made, discussions with staff and the reading of records that this has had a beneficial and positive outcome for those residents, in terms of their own personal development, social interaction and confidence. Staff are to be commended for the work undertaken to achieve this. Menus were seen and these showed that a variety of meals are served at the home. All residents spoken with said that they enjoyed the meals at the home. Mealtimes were observed to be relaxed, with residents choosing where they wished to eat. Some discrepancies were noted within food budgets throughout the home. However following discussions with the Registered Manager the inspector was advised that these are to be reviewed and this will be monitored at future inspections. A number of residents spoke with the Inspector about holidays they have already enjoyed this year or are going on soon. Records seen demonstrated how holiday choices were made and resident involvement in this. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 19 20 Residents are supported and assisted with their personal care needs as appropriate. The health care needs of residents are met and monitored with referrals made to health professionals as appropriate. Generally medication procedures were appropriate with policies and procedures in place. EVIDENCE: The support required by residents in relation to personal care is recorded within their care plans. In addition this information is easily accessible to all staff through the development of the new summary profiles now in use. In some records personalised guidance was seen to be in place which had been developed with the resident and a member of staff, and recorded in the words of the resident. Through discussions with residents it was clear that, with the exception of agreed activities i.e college, daily routines are flexible with residents choosing what they do and when. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 15 A key worker approach is used within the home and residents spoke about their keworkers to the Inspector. Records seen clearly showed that access to other health professionals is obtained as required by individual residents. Any changes to behaviour or health are recorded and guidance and advice received from other professionals is followed and included within care plans. Where residents have specific needs and/or behavioural issues, individualised guidelines are in place. Any incidents arising from episodes of challenging behaviour were seen to be well documented along with the action taken. Administration of medication records were up to date. Some changes have been made since the last inspection. These included a weekly signed record of received medication. A standard format sheet is used for this which also records any discrepancies in the medications received and action taken. Segal House have introduced a medication notice which is displayed on the medicine cupboard and records any changes made to individual residents medication. Staff have now received training in the administration of medication. The home has a pharmacy agreement in place. Staff need to be mindful of expiry dates for medicines with a limited lifespan and they should also ensure that the sharps box is emptied as required. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 All residents have their own bedrooms which are suitable to meet their individual needs. EVIDENCE: Some residents were keen to show the inspector their bedrooms. These rooms are lockable with residents having their own key. One resident had moved to a new room since the last inspection and was happy with the new room, which she had been able to personalise as she wished. Residents advised that they had been able to choose colour schemes and those rooms seen showed that all residents can bring or choose their own furniture and other personal items. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 33 35 36 Staff spoken with during the inspection demonstrated competencies and qualities needed to meet resident’s needs Residents are supported and assisted by an effective staff team. Training courses are made available to staff. Staff support and supervision has been further developed since the last inspection EVIDENCE: Throughout the inspection staff demonstrated a good knowledge and understanding of individual residents needs and how these are to be met, both on a day to day basis and also when dealing with challenging behaviour, particularly the affects that this can have not only on the individual but other residents and the staff team. Staff were seen to be accessible and relaxed with residents who responded well to them. The ratio of staff to residents is higher in Segal House than in the main house, due to the needs of the residents there. This staff ratio allows an effective The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 19 proactive working approach and allows residents to experience a wide range of activities both within and outside the home. Staffing ratios within the main house are sufficient to support the day to day running of the home and allow residents to access activities as outlined in their care plans. However it has been recommended on previous inspections that staffing levels should be reviewed to enable uninterrupted work with individual particularly within the home to allow personal development in areas such as independent living skills. Whilst this is an area not raised by residents at this inspection, staff generally felt that some individual residents would benefit from further one-to-one work. The structure of staff supervision has changed since the last inspection with team leaders in the home taking responsibility for the supervision of care staff. Training in supervision has been made available to staff and those staff who have done this were mainly positive about the training, however some comments were received about the length of training with some feeling that it would have been beneficial to have had longer. However there was general consensus that this change in supervision was a positive one with staff being able to follow through any issues which arose. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Staff enable resident involvement in the day-to-day running of the home which creates an open and inclusive environment. EVIDENCE: There is a clear staff structure within the home, which has been developed since the last inspection. Observations made during the day demonstrated that residents are able to contribute to the day-to-day running both on an individual and group level. This is achieved through staff support, and staff ensuring that they are accessible and approachable to residents. The Old Rectory H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 3 x x x x Standard No 11 12 13 14 15 16 17 3 x x 3 x x 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Old Rectory Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x x x H60-H11 S14787 The Old Rectory V231788 140605 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA33 Good Practice Recommendations The Registered Manager should ensure that there are sufficient numbers of staff to be able to provide uninterrupted work with individuals. 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