Inspection on 02/11/06 for The Tamarind

This inspection was carried out on 2nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Tamarind 17/10/08

The Tamarind 29/11/05

The Tamarind 13/06/05

The Tamarind 01/02/05

The Tamarind 03/09/04

The Tamarind 03/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Tamarind 112 Ramsey Road Dovercourt Harwich Essex CO12 4RN Lead Inspector Ray Finney Key Unannounced Inspection 2nd November 2006 09:30 The Tamarind DS0000017979.V318251.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 Tamarind DS0000017979.V318251.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 Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Tamarind Address 112 Ramsey Road Dovercourt Harwich Essex CO12 4RN 01255 507283 01255 507283 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) A G L Care Limited Mr Steven Brian Lingley Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: The Tamarind is owned by AGL Care Limited and provides accommodation and care for five people with learning disabilities. The home is a detached house situated on the main road into Harwich and offers single accommodation on two levels. All communal areas are situated on the ground floor, and include a lounge, dining area and a kitchen that includes laundry facilities. The dining room has access to the enclosed garden to the rear of the premises. Tamarind is situated on the main bus route and leads to local amenities. Parking is available to the front of the property. Information about the service may be obtained by contacting the manager. The home charges between £941.00 and £1,723.00 a week for the service they provide. Service users pay extra for personal items such as toiletries and admission fees to leisure and recreational activities of their choice; the cost for these is normal retail prices. This information was given to the Commission in November 2006. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to compile this report. The manager provided information in a Pre-inspection Questionnaire. Documentary evidence was examined, such as staff rotas, menus, service users’ care plans and staff files. Completed surveys were received from service users, their relatives and from Health & Social Care professionals. A visit to the home took place on 2nd November 2006; this included a tour of the premises, discussions with service users, members of staff and the manager and observations of interactions between service users and members of staff. Health and Social Care Professionals who were surveyed made positive comments about the home. One said that the “quality of life [for service users placed in the home] has improved significantly with the quality of care” and another said it is “a happy home with helpful and friendly staff”. On the day of the inspector’s visit the atmosphere in the home was lively and welcoming and the inspector was given every assistance from the registered manager, Steven Lingley. What the service does well: What has improved since the last inspection? The home has made some progress with developing the process of quality assurance. The views of service users, staff and others have been sought and are being collated by the area manager. Documentation around the review of risk assessments has improved since the last inspection. The home’s policy and procedure around how to support service users in the event of terminal illness or death has been updated and service users’ wishes around death and dying are reflected in care plans. The Tamarind DS0000017979.V318251.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 Tamarind DS0000017979.V318251.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 Tamarind DS0000017979.V318251.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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have the information they need to make an informed choice about where to live. The home ensures service users are admitted on the basis of a full assessment. EVIDENCE: On the day of the inspection the Service Users’ Guide and the Statement of Purpose were examined. These documents have been updated to reflect the manager’s qualifications. As stated in the Pre-inspection Questionnaire, the Service Users’ Guide is now available in a large print version. For those service users who are unable to read, the manager has obtained the General Social Care Council Code of Practice in symbol format so that staff can use the symbols with service users to explain how staff will support them. Although there have been no new admissions to the home for some time, there is a process in place for assessing service users’ needs before admission. Discussion with the manager demonstrates a good awareness of the assessment process. Records examined show that full assessments of need are in place. The Tamarind DS0000017979.V318251.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): 6, 7 and 9 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 goals are reflected in their Individual Plans. Service users are supported to make decisions about their lives and are supported to take risks within the limitations of their capacity to understand. EVIDENCE: A sample of three service users’ care plans that were examined on the day of the inspection visit all contain detailed, comprehensive information. Care plans contain a ‘general profile’ of the service user and include details of likes and dislikes, a record of activities and what service users like to do around the home. Care plans are well organised and contain sufficient detail to ensure staff provide support/care in a way that meets the service user’s needs and wishes. There is evidence in the records examined that care plans are reviewed regularly. Care plans cover eating & drinking, personal hygiene, communication, bedtime & sleeping, mobility, leisure & occupation, maintaining a safe environment, expressing sexuality, continence and The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 10 management of behaviour. Care plans contain details of what arrangements are to be made around death/dying. Observations of interactions between staff and service users show that staff encourage service users to make choices and take part in the running of the home. Staff were observed to display patience and they listened and responded appropriately. Care plans examined show evidence of how the manager and staff encourage service users to make decisions. The manager informed the inspector that meetings take place regularly with service users to listen to their views on the service. Records examined contain the minutes of the previous service users’ meeting that took place in October. Service users’ records examined show that risk assessments are in place and the care plans relate to the initial assessment of risk. Since the last inspection there has been an improvement in the review process. Records examined show that risk assessments and care plans are reviewed monthly. The manager discussed how the home has a system of setting individual ‘goals’ for service users to help develop skills. The Tamarind DS0000017979.V318251.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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of age, peer and culturally related activities and are part of the local community. Service users are supported to maintain appropriate relationships. The home ensures service users’ rights are protected. Service users are offered a varied and healthy diet that they enjoy. EVIDENCE: Although one service user does some part-time work delivering leaflets, most of the service users living in the home are not able to access paid employment because of their complex needs. However, the home supports service users to take part in a range of activities. Records examined show that service users access local college courses and multi-sensory facilities, the swimming pool, local pubs, trampolining and Aqua Springs. On the day of the inspection visit The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 12 activities such as drawing and artwork were going on in the home and service users were ‘coming and going’ throughout the day. The home ensures family links are maintained and this is well documented in the files that were examined. Surveys were sent to relatives and comments received indicate an overall satisfaction with the home; “is happy and well cared for”, “family and friends are always made very welcome”, “very grateful to all the staff of The Tamarind for their care, patience and understanding”. As previously reported, some service users visit their family home and take part in family holidays. Observations on the day of the inspection visit show that service users are encouraged to be involved in the day-to-day running of the home. Evidence was seen that monthly service user meetings take place. Positive interactions between service users and staff were observed and service users appear happy and relaxed. Care plans contain clear evidence of involvement in daily routines and service users are encouraged to make choices and take part in the running of the home. Discussions with manager and observations on the day of the visit confirm that service users take part, where they are able, in housekeeping tasks. As previously reported, one service user uses public transport. Menus were examined and show that a variety of nutritious food is offered. The small size of the home and the domestic nature of the premises ensure that service users individual wishes around meals are taken into account. There are no set meal times and service users are free to choose when and where they prefer to eat. On a tour of the premises food stocks were examined and fresh fruit and vegetables are available. Discussions with the manager and staff confirm that service users are involved in menu planning, shopping, food preparation and making snacks and drinks. The Tamarind DS0000017979.V318251.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): 18, 19, 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures service users receive personal support in the way they require and their physical and emotional needs are met. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users can expect their wishes to be met around aging, illness and death. EVIDENCE: Records examined show evidence of the way service users prefer to have personal care carried out (see evidence for standard 6). The home operates a key worker system and staff are able to demonstrate an awareness of service users’ preferences. Service users’ records examined show individual preferences around daily routines such as getting up, going to bed and preferences around personal care. As previously reported care plans are comprehensive and clearly identify how service users prefer to be supported. Service users’ records that were examined contain health information including G.P. appointments, weight charts, optician’s and dental clinic appointments. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 14 There is evidence in care plans of medication reviews with the consultant. Comment cards were received from four Health and Social Care Professionals; all made positive comments including “quality of life has improved significantly with the quality of care”, “a happy home with helpful and friendly staff” and “I am satisfied with the care provided”. The home operates a monitored dose system for medication. There are currently no service users living in the home with the capacity to self medicate. Medication is stored appropriately in a locked cupboard. Medicine Administration Record (MAR) sheets were examined on the day of the inspection visit and are completed appropriately. Staff files contain evidence of training around medication. Procedures and practices around the administration of medication are good. The home has an appropriate policy around death and dying, which was revised and updated in July 2006. Service users’ records examined contain details of what arrangements are to be made in the event of terminal illness or death. The Tamarind DS0000017979.V318251.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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident their views are listened to and acted on. Arrangements are in place to help protect service users from abuse, neglect and self-harm. EVIDENCE: The home has an appropriate complaints policy and procedure in place, which was revised and updated in July 2006. There is suitable documentation in place for recording complaints; no complaints have been recorded since the last inspection. On the day of the inspection visit the process was discussed with the manager, who showed a good awareness of his responsibilities around dealing with concerns and complaints. Surveys received from relatives all indicate that they are aware of the complaints procedure but have not had to make a complaint. Records examined show that the home has policies in place for the Protection of Vulnerable Adults (POVA). There is a whistle blowing policy in place so that staff may be assured that they will be protected if they feel the need to raise concerns about practices. As part of the recruitment process, the home carries out Criminal Records Bureau (CRB) enhanced disclosure checks to ensure the protection of service users. Training records examined indicate that staff have had POVA training. The Tamarind DS0000017979.V318251.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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users live in a homely, comfortable and safe environment and they can expect the home to be clean and hygienic, although bathrooms are in need of refurbishment. EVIDENCE: From a tour of the premises the inspector observed that overall the environment is comfortable and the home is well maintained. The furniture throughout the home is domestic in nature and of good quality. Service users’ bedrooms that were examined all have plenty of evidence of personal property such as music systems, an exercise bike, videos/DVDs and personal photographs. Bedrooms are decorated to meet individual tastes. Overall the premises are clean with no unpleasant odours. Since the last inspection visit the kitchen has been redecorated and the bathroom part-tiled. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 17 Both bathrooms are clean, but contain older style bathroom suites that are in need of replacement. The downstairs bathroom has an older style assisted bath, which is not used by the current service user group. The upstairs bathroom contains a burgundy coloured bath and toilet but the basin and pedestal have been replaced with a white set, as the original colour is no longer available. This looks out of place and mis-matched and the environment for service users would be improved if this bathroom were refurbished. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users are supported by competent and qualified staff who receive appropriate training, although the manager should ensure staff are supported to complete NVQ awards. Service users are protected by the home’s recruitment policy and procedures. Service users benefit from wellsupported and supervised staff. EVIDENCE: Overall the staff team are competent and qualified to carry out their roles. Discussion with the manager and information provided in a pre-inspection questionnaire indicates that 5 of a total of 14 care staff have completed a National Vocational Qualification (NVQ) at level 2 or above and another member of staff is due to start the award in January. Although this falls short of the National Minimum Standard’s recommended 50 , the manager is committed to increasing the numbers of staff with an NVQ qualification. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 19 The home has a robust recruitment process in place to ensure the protection of service users. The manager is able to demonstrate a good awareness of the requirements of the standards relating to the recruitment of staff. Staff files examined contain all the required documentation including two written references, appropriate evidence of identification (ID), photographs and enhanced Criminal Record Bureau (CRB) checks. Staff files are very well organised. As previously reported, staff are given a copy of the General Social Care Council (GSCC) Code of Practice. Records examined show that the home has a good training and development system. Training in past year includes Fire Safety, Food Safety, Medication, Health & Safety, POVA and Working in Care Induction Standards. Further training is planned for First Aid, Management of Challenging Behaviour and NVQ for further 2 staff. Staff files contain evidence of staff induction and regular supervision. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and had policies and procedures in place to safeguard the rights of the service users. Overall service users views are taken into account through the Quality Assurance process. The home ensures the health, safety and welfare of service users are promoted and protected. EVIDENCE: The registered manager has a number of years management experience and has recently completed the Registered Manager’s Award. Discussions with manager indicate he has a good awareness of the procedures needed to run the home. An open atmosphere and good interactions were observed between the manager and members of staff. The home has a range of policies that the The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 21 manager implements to ensure the home is well run in the interests of service users. Discussions with the manager indicate that further progress has been made with the home’s Quality Assurance process. Questionnaires were distributed in August 2006 to service users, members of staff, relatives and other professionals involved with the home. The area manager is in the process of collating the information received, although a final report has not yet been produced and made available to all stakeholders and other interested parties. Service user meetings are held approximately monthly; the minutes of the last meeting, held in October 2006, were examined. The manager is able to demonstrate a good awareness of how to use the information collected to improve the service. The home has appropriate policies and procedures in place around infection control, control of substances hazardous to health (COSHH), fire safety, food safety, first aid and Health & Safety. Policies were reviewed in July 2006. Information provided in the Pre-inspection Questionnaire and records examined indicate that appropriate Health & Safety checks are carried out. Health & Safety records examined show that fire alarms are tested regularly, fire drills are carried out, emergency lighting is checked, a safety certificate is in place for the gas system, water and freezer temperatures are checked regularly. Records relating to Health & Safety are all well maintained. The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 22 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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 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 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 2 X X 3 X The Tamarind DS0000017979.V318251.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA39 Regulation 24(2) Requirement The registered person must provide a report in respect of the Quality Assurance process and make a copy of the report available to service users and their representatives. Timescale for action 31/03/07 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. 2. Refer to Standard YA24 YA32 Good Practice Recommendations The registered person should consider the replacement of the old, outdated bathroom suites to improve the environment for service users. The registered manager should continue to support staff to obtain an NVQ qualification at level 2 or above. 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