CARE HOME ADULTS 18-65
The Pines - Redhill 2 College Crescent Redhill Surrey RH1 2HP Lead Inspector
Mrs Pauline Long Announced 11 August 2005
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 Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Pines Address 2 College Crescent Redhill Surrey RH1 2HP 01737 277716 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) Surrey Oaklands NHS Trust Mrs Khatijah Joosub Care Home 6 Category(ies) of LD - Learning Disability (6) registration, with number of places The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 3. The age/age range of the persons to be accommodated will be 18-64 years. Date of last inspection Brief Description of the Service: The Pines ia a care home, which opened in 1997 and is run by Surrey and Borders Partnership. The service provides care and accommodation for six younger adults of both sexes with a learining disability. The premises are owned and maintained by the metroplitian housing association. The home is a detached purpose built bungalow. The accommodation consists of 6 single bedrooms, a comfortable sitting room, dining room, and adequate toilet and bathing facilities. The internal decorations and furniture are in a satisfactory condition. There is a patio and garden to the rear of the property and parking space at the front of the property. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first Inspection of the CSCI year April 2005- March 2006 and was announced. The inspection was carried out by one inspector and lasted for four hours. On the day of inspection the service had a homely and welcoming atmosphere. All but two of the residents were at home. Two residents were away on holiday. All of the residents and all of staff on duty were involved in the inspection process. During the inspection process, evidence was gathered in the following ways: • • • • • • • • Discussions with the manager. Discussions with the staff. Direct observation of interactions between the residents, manager and staff. Examination of resident’s, staff and service records. Feedback from the last inspection reports. Feedback from the pre inspection questionnaire. Feedback from a significant number of service user comment cards. Feedback from a visitor at the home The feedback from the resident’s at home on the day was limited, in view of their communication difficulties. CSCI would like to thank the residents and staff for their hospitality and cooperation during the inspection. What the service does well:
This home presents a homely environment and atmosphere for the residents. Both the manager and care staff demonstrated an in-depth knowledge of the residents care needs and this was reflected in the wellbeing of the resident’s who were at the home on the day. The manager demonstrated an open and inclusive style of management. The staff on duty appeared comfortable and confident in the managers presence. Two members of staff on duty on the day of the inspection had worked at the home for some time. One of them said the training at the home was good and that she liked working with the residents. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 6 The home is committed to ensuring that the residents maintain contact with family/friends and the local community. One family member commented that, the home is always tranquil, clean and has a happy atmosphere. There are various activities offered both in and outside the home. There are many colourful pieces of sensory equipment placed through out the home, which were good for the residents with communication difficulties. The staff should be commended on the attention they have paid to sensory stimulation through out the home. What has improved since the last inspection? What they could do better:
The organisation has recently changed its name. The policies, procedures and paperwork in the home do not reflect the new name. In order to minimise confusion for service users, all documentation should reflect the organisations new name. Continence aids were stored in the main bathroom. This indicated communal use of these items. In order to promote the dignity of the residents, all continence aids must be for a named resident, and must be stored in a named residents bedroom. It was observed that toiletries were kept in the main bathroom. These were not stored according to COSHH ( Control of Substances Hazardous to Health) regulations. In order to ensure the safety and well-being of all of the residents an alternative place must be found to store these items. Towels were also stored in the bathroom. This also indicated communal use. In order to promote the dignity of all residents, towels must be provided on an individual basis, and these must be stored in a residents bedroom. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 7 On the day the laundry door was unlocked. The cupboards, where cleaning materials were kept was unlocked. In order to ensure the safety and well-being of the residents the laundry door must be locked when not in use. The cleaning cupboards must be kept locked at all times. Food stuffs, stored in the fridge were not stored in compliance with Food safety regulations. In order to ensure the safety and well-being of the residents and staff, all food must be stored safely. There was a discrepancy with a residents personal account. In order to ensure that a resident is protected from abuse, the manager must ensure that the all of the staff comply with the organisations policies and procedures in respect of residents personal finances. Whilst the garden is maintained reasonably well in respect of hanging baskets and flower pots, the pathways and patio area require attention and the grass needs to be cut, this will ensure that the resident’s have a comfortable and safe environment in which they can spend time. 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 Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 8 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 Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 9 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) 1,2,4,5 Arrangements are in place to ensure a full needs assessment takes place before any new admission. The arrangements in place for prospective residents to “ test drive” the home are good. Service user contracts were in place, but not all of them were signed. EVIDENCE: There have been no new admissions to this home for some time. Residents files were sampled, each resident had a comprehensive assessment of needs, which, in the first instance was carried out by the previous manager at the home. All aspects of daily living needs were assessed, indicating that the manager and care staff would be fully aware of individual residents care needs. Each prospective resident was offered the opportunity for several visits to the home prior to a trial assessment period. These periods range from a lunchtime visit, to a weekend stay. The residents files inspected on the day had contracts in place. This was presented in a clear and easily read format. However, none of the contracts were signed, by either a resident or an advocate, the managers signature was on some of the contracts. This was discussed with the manager, who stated that the social services care management team had refused to sign these contracts.
The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 10 A requirement has been made in this respect. Please refer to page 23 of this report. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 11 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 of the residents care plans, and a detailed needs assessment had also been completed and reviewed. On the day of inspection resident’s were observed being enabled to make choices safely. Residents are consulted on aspects of life in the home. EVIDENCE: The staff on duty on the day had a good understanding of the resident’s personal care needs. This was evident from the positive interactions and relationships observed. Care plans included all aspects of personal support and health care needs. Residents had an individual communication profile, which shows how an individual would communicate with others. Some profiles were in pictorial formats. Risk assessments were in place and had been reviewed. There are house meetings in which the residents can air their views. The minutes of these meeting were supplied in written and pictorial form. Staff were at hand to support and offer supervision to all of the resident’s who needed help whilst also being mindful of residents choice. It was pleasing to
The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 12 note that one member of staff was singing to the client, who responded by clapping her hands and laughing, indicating that she was happy. All of the residents files were stored appropriately and securely in the managers office. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 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 standard(s) 12,13,14,15,16 The Manager and staff enable the residents to maintain fulfilling lifestyles in and outside the home. The home promotes contact with family, friends and the local community. None of the residents are in paid employment. EVIDENCE: On the day of inspection, four residents were at home. Two of the other residents were away on their annual holiday. Plans have been made for the other residents to go on holiday later on in the summer months. The routines in the home were determined only by the timings of the visits to and from the day services and to other appointments. The Manager stated that the residents are encouraged to observe the staff, whilst they carry out the domestic duties around the house. On the day all of resident’s were observed moving around the home with out restriction. One resident was observed watching a programme on the television. Another was playing with the sensory equipment and her facial expressions and sounds indicated that she was enjoying herself. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 14 It was pleasing to note that one resident went out to the local swimming pool after lunch. One of the residents attends a weekly cookery class at a local day service. The home is committed to ensuring that the residents maintain their relationships with their family and friends. Residents receive regular visitors. and families keep contact by phone. One family member commented that, she was very happy with all aspects of her daughters care and that when she visits she is made to feel part of the team. The care staff stated that, the residents were able to choose their meals. The manager stated that one resident in particular enjoyed the food preparation. The homes menus have recently been reviewed and new menus are now in place. It was disappointing to note that there was no evidence of pictorial menus being used. Lunch was served at the kitchen table and consisted of pasta and cheese. Staff were observed helping to feed those residents who required help. This help was provided in a sensitive manner. Special diets are arranged for residents with specific dietary needs. A recommendation was made in this area. Please refer to page 23 of this report. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 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) 18,19,20, The manager and staff have a good understanding of the residents personal, physical and emotional support needs. The systems for the administration of medication are good with clear, comprehensive and effective arrangements in place. EVIDENCE: Care plans included clear guidelines on any support each resident required with personal and health care. Physical and emotional needs of the residents were also detailed in the care plans and daily records, which included visits to the doctor, dietician, dentist and reviews of care. Feedback from a General Practitioners surgery indicated, good working relationships between the home and surgery. There were records with regard to the activities and care being given. The inspector sampled the daily observations records and communication book, in which the general activities and incidents of daily living in the home were recorded. The organisation’s medication policies and procedures were comprehensive, however the home does not have a local policy regarding medication. Residents medication record sheets were sampled and were found to be properly completed. A member of care staff was observed administering
The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 16 medication according to the medication policy. None of the resident’s at the home administers their own medication. A recommendation has been made in respect of medication. Please refer to page 23 of this report. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 17 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 The home has satisfactory policies and procedures in place for dealing with concerns, complaints and the protection of the residents. EVIDENCE: CSCI have received no complaints about this home since the last inspection. There were no complaints documented in the home’s complaints folder. The manager is aware of and has attended the Surrey Multi Agency Abuse training. All of the staff at the home have attended abuse training. The home holds regular resident’s meetings in which the residents have an opportunity to express their views. It was pleasing to note that the minutes of these meetings were in written and pictorial format. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 The standard of the environment within this home is good and meets the needs of the residents, providing an attractive and homely place to live. EVIDENCE: All of the resident’s bedrooms were personalised. They were comfortable, and the quality of the bedroom furniture and the decoration was good. There were many soft toys and other personal items around, photographs of family members and residents were observed. The sitting room was comfortable with adequate seating. However the manager stated that new sofas and armchairs had been ordered. The standard of decoration in the home was satisfactory. There is an ongoing programme of redecoration. One of the resident’s bedrooms had been recently decorated. The bathrooms and toilet’s were bright, clean, domestic in appearance, and had been well adapted in order to meet the residents needs. As stated earlier in the summary of this report there was evidence of communal use of continence aids, towels and toiletries. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 19 It was pleasing to note that, most of the rooms in the home including the bathroom were well equipped with sensory equipment. The garden was well maintained in respect of hanging baskets, flower pots and plants. However the patio area, pathways and grass require attention. On the day the home was clean and free from offensive odours. A requirement has been made in this area. Please refer to page 25 of this report. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,35,36 The recruitment practices in this home are good. Staffing arrangements in place on the day of inspection were sufficient to meet the needs of the service users. The staff were competent and were clear about their roles and responsibilities. There is a staff supervision programme in the home. EVIDENCE: The home has clear policies and procedures for staff recruitment. No new members of staff have been recruited since the last inspection. Staff files seen on the day demonstrated thorough recruitment and selection practice. All staff had satisfactory references and Criminal Records Bureau and Protection of Vulnerable Adults checks. There were 2 care staff and the manager on duty the morning shift. Two members of staff had accompanied the other residents on their holiday. The home benefits from a stable staff team. The manager stated that the home was almost fully staffed, however agency staff are used on occasion. Staff talked about their job roles, there was awareness of the different roles and responsibilities within the home. Staff also discussed the training opportunities in the home. The homes training records gave examples of the following training:
The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 21 • • • • • • • • • Medication. Manual handling. 4 day First Aid . Health and Safety. Fire Awareness. Food Hygiene. Vulnerable Adults. Multi sensory training. Mini bus driving. There is a staff supervision programme in the home. The manager and deputy carry out the supervisions. To date supervision targets have been exceeded. group supervision is carried out on a monthly basis. The minutes of these meeting are kept on file and all staff who attend these meeting sign to indicate attendance. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 37, 38, 39,40, 41, 42,43 The home is well run. Policies and Procedures were in place to safeguard service users and the standard of record keeping was good. The Manager is experienced and qualified to run the home. Health and safety checks are routinely carried out at the home. There were some concerns regarding health and safety. There was a discrepancy in the financial record keeping. EVIDENCE: On the day of inspection the manager demonstrated an open approach and management style. From observation of her interactions with residents and staff it was clear that there was an atmosphere of openness and respect. There are comprehensive policies and procedures in the home. Residents and staff can access them when they wish. Health and safety checks are routinely carried out at the home. All equipment in use on the day of inspection was properly maintained. Water temperatures were checked and all were within the required range.
The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 23 As mentioned in the summary of this report. It was observed that toiletries were kept in the main bathroom. These were not stored according to COSHH ( Control of Substances Hazardous to Health) regulations. The laundry door was unlocked, although the key was in the lock. The cupboards, where cleaning materials were kept was unlocked, again the key was in the lock. Food stuffs, stored in the fridge were not stored in compliance with Food safety regulations. Open packs and jars of food had not been dated. The home holds regular resident’s meetings in which the residents have an opportunity to express their views. It was pleasing to note that the minutes of these meetings were in both written and pictorial form. Throughout this inspection the home records were accessed. The recordkeeping was of a high standard. Records are stored appropriately, securely and confidentially. Requirements were made in these areas. Please refer to page 23 of this report The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 24 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 3 x 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 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 3 3 3 3 2 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 3 x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Pines - Redhill Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 2 2 H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 25 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 YA 1 Regulation 4(c ) Schedule 1 12(4)(a) Requirement The registered person(s) must ensure that all documentation reflects the organisations new name. The registered person(s) must ensure that continence aids are stored in a residents bedroom and not in the bathroom. The registered person(s) must ensure that a residents towels are stored in a residents bedroom and not in the bathroom. The registerd person(s) must ensure that all hazerdous substances are stored according to COSHH regulations. An alterntive storage must be found for the toilteries. The registered person(s) must ensure that the laundry door is locked and that the key is removed, each time a member of staff leaves the laundry unattended. The registered person(s) must ensure that food stuffs are stored in complaince with Food Safety Regulations. The registered person(s) must ensure that the garden, patio Timescale for action 11/11/05 2. YA 18 11/9/05 3. YA 18 12(4)(a) 11/9/05 4. YA 42 13(4)(a) 11/9/05 5. YA 42 13(4) (a) 11/9/05 6. YA 42 12(1)(a) 11/9/05 7. YA 42(3) (vi) 23(2)(o) 11/10/05
Page 26 The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 8. YA 23 13 (6) 17 (2) Schedule 4 and pathways are appropriately maintained. The registered person(s) must ensure that residents personal financial records are checked regularly and that any discrepancies are dealt with in a timley fashion. 11/9/05 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 YA 20 Good Practice Recommendations The registered person(s) should consider developing a local medication policy. The Pines - Redhill H58_s13748_The Pines_v227957_110805_stage2.doc Version 1.30 Page 27 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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