Inspection on 27/10/05 for The Old Rectory

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14/06/05

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 Announced Thursday 27 October 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 V248669 271005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address Singleton, Chichester, West Sussex, PO18 OHF 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 Ltd Mr Clive Lucas Care Home 27 Category(ies) of PC Care Home only 27 registration, with number of places The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14/06/05 Brief Description of the Service: The Old Rectory is registered to accommodate twenty seven 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 privately owned by the Dignity Group Ltd. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Announced Inspection which took place over 11 hours, including a return visit made on 11th November 2005. Prior to the inspection the Registered Manager provided requested information within a completed preinspection questionnaire. The inspector also reviewed the previous inspection report and any correspondence or notifications received. During the inspection the inspector undertook a tour of the home and spoke with residents and staff. The Inspector was also able to attend a residents service review meeting. Residents were generally positive about life at the home and the opportunities available to them. Relatives seen were very happy with the personal development and achievements of their daughter since she had moved into the home. What the service does well: What has improved since the last inspection? What they could do better: Residents and staff did advise that on occasions there were delays in rectifying identified repairs. Staffing organisation and structure could be reviewed to ensure that they are able to effectively meet the needs of all residents within the home. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 6 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 V248669 271005 Stage 4.doc Version 1.40 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 V248669 271005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 All prospective residents have a full assessment of their individual needs prior to moving in. All prospective residents are able to visit and stay at the home prior to making a decision about moving in. EVIDENCE: Three new residents have moved into the home since the last inspection. One of these residents has transferred from another home owned by the Registered Providers. The other two residents had had a full assessment of their needs undertaken prior to moving in to the home. Records seen and discussions with residents and staff showed that the new residents had visited the home and had short stays at the home prior to moving in permanently. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 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. The assessed needs and individual goals and objectives are included within a detailed care plan for each resident. Residents are supported to make decisions about their own lives. Residents are able to participate in the day to day running of the home. Residents are supported by staff to take risks as part of an independent lifestyle. EVIDENCE: All residents have a care plan in place which records information as to their personal, health and social care needs and how these are to be met and maintained. A sample of care plans was reviewed at this inspection. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 10 Daily records are kept for each resident, which record activities undertaken, any health issues and action taken (including referrals to doctors or other health professionals). These records are reviewed monthly when a summary form is completed. These records demonstrated a flexibility within the daily routines and also showed, outside of planned and agreed activities i.e. college and clubs, how residents are able to choose how they spend their days. The care plans are reviewed regularly with formal reviews every six months. These reviews involve the resident, their relatives, their key worker, the home manager and any other social care and health professionals involved in their care. On the day of inspection a care plan review was being held which the inspector was able to attend with the consent of the resident. The agenda of the meeting was set around the wishes of the resident who was able to fully participate. She was able to share her experiences of life at the home and express her wishes and aims for the future. These aims and wishes then form her objectives which the staff team will support her to achieve. Her relatives confirmed that moving to the home had been a positive experience for her and they expressed great satisfaction in her personal development and achievements since moving in. Through the review meeting, discussions with residents and staff and through records seen it was clear that residents are able to make decisions about their own lives. Where support is needed with this, it is provided by the staff team. This may be through discussions, obtaining and providing information or through developing effective communication support for individual residents. It was clear throughout the inspection that residents are able to participate in the day-to-day running of the home. Resident meetings are held however residents were observed throughout the day to discuss a variety of different issues with staff, make decisions regarding meals and snacks, decide what they wished to and when. Risk assessments are in place which show that staff assess potential risks for residents. A new format of risk assessment has been developed within Segal House through which any potential risks are assessed, monitored and reviewed. These provide detailed information and demonstrate how decisions have been made and what action has been taken to minimise the risks. They also demonstrate how staff have supported residents to minimise any risks thus enabling them to access a wider variety of educational and recreational activities. The Registered Providers should give consideration to introducing this system across the home. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 11 It was again demonstrated at this inspection that the staff continue to enable residents to participate as fully as they can in life at the home whilst supporting them to enjoy a range of opportunities outside of the home. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 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, 15, 16, 17 Opportunities for personal development are available to residents both within and outside the home. Residents enjoy a range of educational, social and leisure activities. Residents are supported as necessary to access the local community. Residents are supported to maintain family and other friendship links. Residents choice and freedom of movement is promoted within the home. A varied and balanced diet is provided at the home. EVIDENCE: Records seen and discussions with residents and staff demonstrated that all residents have opportunities for personal development. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 13 This may be through staff support in developing practical life skills within the home i.e meal preparation and staff support outside of the home i.e. budgeting skills whilst out shopping, or through college courses. It was evident through records seen, discussions with staff and observations made that further work has been undertaken within Segal House, to continue to improve and increase the range of activities available for the residents to enable them to further develop social, emotional and communication skills and the staff are to be commended for this. Other residents also have opportunities to access a range of college courses. Residents advised that they choose these themselves with some support from staff as necessary. Through discussions with residents it was clear that they are supported to access the local community. They spoke of shopping trips, going to coffee shops and cafes, swimming. Residents also spoke of holidays they have enjoyed over the summer period (the Registered Providers pay an amount towards the cost of this). Of the comment cards completed by residents 81 were satisfied with the activities provided by the home. Of those residents spoken with who advised that they would like more activities, these tended to be requests for trips out, walks in the area or visiting local shops and cafes, particularly at weekends. Residents spoke of visits to their family and friends and regular phone calls they make to them. All residents, within the main house, are able to have a key to their rooms. Within Segal House this has been assessed as not appropriate for all residents, at the present time due to the capacity of the current residents. Mail for residents was seen to be given unopened, with residents requesting staff assistance as necessary. 87 of residents through the comment cards were satisfied that staff respected their privacy. Observations made during the inspection reflected that staff did respect individual privacy. It was clear that residents chose where they wish to be in the home, either with residents and staff or on their own and all have unrestricted access to the home. A menu for main meals during the day is drawn up taking into account individual likes and dislikes. There is a choice of main meal which during the week is served in the evening. Residents were observed to participate in meal preparion and clearing away. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 14 81 of residents who completed comment cards advised that they liked the food served in the home. All residents spoken with during the inspection said that they enjoyed the meals. Food storage areas were seen during the inspection. It is recommended that the storage of fresh fruit and vegetables in particular is reviewed as it was noted that the storage cupboard currently used is very damp. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 15 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) 20 Good practices of medication administration were observed. EVIDENCE: There are policies and procedures in place for the administration of medication. Staff have received training in this area. Since the last inspection a new procedure has been introduced with two staff now administering medication. Staff spoken with considered that this was an important improvement increasing the safety of medication administration. Medication was seen to be kept within locked cupboards however it is recommended that two of these cupboards within the main house are reviewed to ensure that they meet current good practice and guidelines. All medication records were up to date. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 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) 22, 23 There is a complaints procedure in place which is provided to residents and their representatives. There are policies and procedures in place to safeguard residents from abuse. EVIDENCE: There is a complaints procedure in place. No complaints have been received. Of those residents who completed a comment card 19 advised that they were unsure of who to speak to if they were unhappy about their care and the Registered Manager should address this. During the inspection all residents spoken with, when asked, advised that they would speak to staff and/or their key worker if they had any problems. Staff have received training in adult protection and there are appropriate policies and procedures in place. Staff maintain good working relationships with the Community Team for People with Learning Disabilities and the Inspector is satisfied through discussions with staff and the Registered Manager and through notifications received under regulation 37 that the staff team are aware of their role and responsibility in safeguarding the residents. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 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) 24, 25, 30 The Registered Providers need to ensure that all identified repairs are rectified in a timely fashion to ensure that the environment remains safe and comfortable for residents and staff at all times. Residents own rooms meet their needs and promote their independence. The home is generally clean and hygienic. EVIDENCE: Information provided by the Registered Manager show that recent routine visits have been undertaken to the home by both the fire safety officer and the environmental health officer and that any requirements have been implemented. A number of outstanding repairs were noted during the inspection. A maintenance plan for the next three months was seen during the inspection but this did not include any details of the repairs noted. During the return visit to the home these repairs were discussed with the Registered Manager who confirmed that the majority of repairs identified during the inspection had now been rectified. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 18 However feedback from residents and staff during the inspection did identify that they had experienced delays in some repairs being carried out and the Registered Manager must ensure that all repairs are undertaken in a timely fashion and the reasons for any delays are documented. Two residents in the upper flat are experiencing problems with water dripping through a ceiling and mould appearing on the ceiling and walls. On inspecting part of the roof through an upper window, this showed that there are cracked and loose tiles and a big build up of moss, grasses and other plants. Further damp was also noted within the front entranceway. The Registered Manager is requested to confirm in writing to the Commission any works programmed to address the above repair issues. There is a separate laundry area which residents are supported to use. This is separate from areas where food is prepared and eaten. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 19 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, 34, There is a competent and qualified staff team at the home. Residents are supported by an effective staff team. The Registered Providers should ensure that their recruitment procedures are followed for all new members of staff. EVIDENCE: During the inspection residents were observed to be relaxed and comfortable with the staff team. Staff are always available to speak with residents, who were observed to go and speak with staff about a variety of issues throughout the day. Staff are able to communicate effectively with all of the residents. Staff demonstrated a good understanding of the needs of the residents and how these were to be met. The Registered Manager confirmed that 90 of the current staff team have an NVQ level 2 or above. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 20 Within Segal House there is a higher ratio of staff to residents to enable them to meet the specific needs of the residents. These staffing levels enable uninterrupted work with individuals and has meant that the range and type of activities and opportunities for residents continues to increase and develop. It has been noted on previous inspections that the staffing levels within the main house, whilst ensuring the day to day running of the home and enabling residents to access agreed activities as detailed in their care plans, does not always allow staff to work with individual residents. There are some residents who have particular identified needs and display challenging behaviour. Although they receive some 1-1 support, this is limited and outside of these additional hours the existing staff team have to meet the needs of these residents which on occasion prevents them from providing support and other opportunities from the other residents. It is recommended that the Registered Manager reviews how the staff team are organised throughout the home to ensure an appropriate and effective use of the current staff team and their particular skills and experience. Staffing rotas seen also show that there has been a need to use agency staff on occasion. Staff confirmed that wherever possible they use the same staff and this was evidenced on the day of inspection. Recruitment records were seen for staff employed since the last inspection. These showed that generally the home follows a robust recruitment procedure with all checks and documentation in place prior to the commencement of employment. It was noted that this was not the case for one member of staff for whom only one reference had been received. On starting work this member of staff gave immediate notice of her intention to leave. However the Registered Provider must ensure that their policy and procedure is followed for all staff and that all checks and documentation required by regulation is received prior to staff commencing employment at the home. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 21 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) 39, 42 The home has a quality assurance system in place however this could be further developed to ensure that all interested stakeholders are involved in this process to enable the Registered Providers to fully measure the success in achieving the aims and objectives of the home. The health, safety and welfare of residents is generally promoted and protected however the Registered Providers must address the delays experienced by some residents in carrying out repairs. EVIDENCE: There are appropriate policies and procedures in place to maintain the health and safety of residents and staff. Staff receive training in safe working practice areas. Information provided by the Registered Manager through the pre inspection questionnaire demonstrated that equipment and services within the home is maintained. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 22 Accidents and incidents are appropriately recorded and the home notifies the Commission of any reportable incidents under regulation 37 of the Care Home Regulations 2001. A number of issues have been raised about the management of repairs within the home and these were discussed with the Registered Manager during the return visit. Whilst is was confirmed by him that the majority of these repairs had now been done as residents and staff spoke of general delays to repairs and this needs to be addressed by the Registered Manager. The Old Rectory H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 23 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 x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 2 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Old Rectory Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H60-H11 S14787 The Old Rectory V248669 271005 Stage 4.doc Version 1.40 Page 24 Are there any outstanding requirements from the last inspection? NO 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 AP24 Good Practice Recommendations The home should have a planned maintenance and renewal programme for the fabric and decoration of the premises, with records kept. 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