Inspection on 19/08/05 for Theobald House

This inspection was carried out on 19th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Theobald House 05/11/08

Theobald House 15/02/07

Theobald House 18/01/06

Theobald House 28/02/05

Theobald House 27/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Theobald House 46 Dartmouth Avenue Bath Bath & N E Somerset BA2 1AT Lead Inspector Sarah Webb Unannounced 19th & 22nd August 2005 09:45 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. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Theobald House Address 46 Dartmouth Avenue Bath Bath & N E Somerset BA2 1AT 01225 338567 01225 338567 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) New Era Housing Association Limited Ms Carol Christine Fyrth PC Care home 4 Category(ies) of LD Learning disability (4) registration, with number PD Physical disability (2) of places Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 4 persons aged 18 - 65 years requiring personal care only. Date of last inspection 28-Feb-2005 Brief Description of the Service: Theobald House is a care home operated by New Era, an independent voluntary organisation, to accommodate up to four people - two with a learning disability and two with a learning and physical disability. Bath and North East Somerset Council own the building. The home is situated in the Oldfield Park area of Bath in a quiet cul-de-sac. The home is within a five minute walk of Moorland Road, which offers a range of facilities including grocery stores, florists, shoe shops and hairdressers. Bath city centre is only a five minute drive from the house. The house itself is modern in design and offers accommodation on two floors. There are six single bedrooms in total, two on the ground floor, one of which is equipped with a wash hand basin, and four on the first floor, two of which are used by two staff members who provide sleep-in cover. There are two communal lounge areas, and a dining room on the ground floor. The home provides sufficient bathrooms and toilets; the ground floor bathroom is equipped with a ceiling track hoist, and an adapted whirlpool bath facility. The home has specific equipment for service users accommodated based on an assessment of their individual need. There is ongoing discussion concerning the reconfiguration of the building in order to provide a suitable environment and meet the assessed needs of 2 individuals. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as an unannounced inspection and took place over a period of 2 days and a total of 4.5 hours. The inspection methods used included observation of documentation, record checks, case tracking and discussion with staff. Although the registered manager was not available, staff on duty were helpful and able to support with the inspection process. Two individuals receiving a service were met during the inspection. It was not possible to have in-depth discussions with individuals due to their communication difficulties but interaction between themselves and staff was observed. What the service does well: What has improved since the last inspection? How individual medication is administered is now included in care plans and medication profiles. The home has begun the process of training staff in manual handling in order to offer best practice when supporting individuals with their personal care and to maximise the health and safety of staff. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 6 The home has begun maintaining the garden area. Training records have been updated. 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. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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 Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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) 2 & 3 The assessed needs and preferences of tenants are met and there are processes in place for the review of their care. The staff have a good understanding of the individuals’ support needs through the maintenance of positive relationships. EVIDENCE: As the manager was not available, it was not possible to follow up a requirement from the last inspection for the manager to be provided with an easy to understand document, which clearly sets out the fee charges that relate to the individual service users and how these fee charges are made up. This will be followed up at the next inspection. There have been no changes since the last inspection, in relation to the four people accommodated at the home. Three of the four people have lived together at the home for many years. The fourth person was admitted in 1999. There was documentation in place evidencing that all tenants are funded by the local authority and had been admitted to the home through the care management process. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 9 It was evident that the home is meeting the care needs of the individuals; this was demonstrated through care planning and the home’s system of review. The home also works closely with specialist services in order to support individuals and offer advice to staff. Staff continue to work through a specific form of communication called Intensive Interaction; a staff member said this approach has helped in meeting an individuals needs. Observation of positive interaction between staff and tenants demonstrated an understanding of both the staff role in the home and individuals needs. It was evident through discussion with staff that they continue to maintain a positive attitude towards supporting individuals. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 10 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, 9 There is a clear and consistent care planning system in place to adequately provide both tenants and staff with the information they need to satisfactorily meet individual needs. The home encourages individuals to make decisions regarding their lifestyle. The home has risk management procedures in place to ensure individuals are supported safely in taking risks. EVIDENCE: The home has continued to review individuals’ care plans on regular basis. Those care plans observed were all up to date and had been reviewed, signed and dated. This is good practice. Care plans provided comprehensive information for staff in order to meet needs of individuals; this included communication needs, mobility, current daily routines, health checks and risk assessments. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 11 It was evident through discussion with staff and observation of individuals’ records that tenants are supported to make decisions and choices about their lifestyle. Any restrictions in place to safeguard tenants welfare are documented within their individual care files. Tenants are unable to manage their own financial affairs. The manager of the home is appointee for three individuals’ savings accounts. There was clear documentation in place regarding individuals’ financial transactions and how they are supported by staff. Risk assessments had been completed and reviewed on a regular basis and aspects of activities of daily living and behaviours specific to the individual are included in detail to direct staff. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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, 13, 14, & 16 Links with the community are good and support and enrich tenants’ social and educational opportunities. The home offers individuals opportunities to lead active and fulfilled lifestyles which are both age appropriate and reflect their levels of independence. Individuals are treated with respect and dignity through all aspects of the daily routines of the home. EVIDENCE: There is no change in that two tenants are limited in their ability to carry out domestic tasks and independent living skills due to the profound nature of their disabilities. It was evident through documentation that staff encourage and support the two other individuals with their personal development. It was evident through discussion with staff and observation of records that individuals continue to access opportunities in the local community. The four tenants also attend an external planned day service. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 13 Currently transport continues to be provided through use of a leased minibus; individuals contribute a proportion of their mobility allowance to cover the cost. A staff member said that alternative transport is being considered. In response to concerns about the organisation’s charging policy for transport, the Commission has been informed that this is being reviewed through the organisation’s regional plan for the South West. It was evident through records that individuals are encouraged, supported, and stimulated in pursuing interests and hobbies. One individual enjoys musical concerts; the home is to be commended in supporting this person with accessing a diverse range of musical opportunities. There is no change to the practice of the bedrooms not being fitted with a lock; tenants do not have keys to their bedrooms. One person has a key to the front door and is encouraged to use this whenever they return to the house after a trip out with a staff member. Observation at the time of inspection and discussion with staff provided evidence that individuals are treated with respect and dignity. Staff are aware of the needs and preferences of individuals and communication continues as an ongoing practice in all activities. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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 Personal support is offered in such a way to promote and protect individuals privacy, dignity, independence and preference. The physical and emotional health needs of individuals are well met with evidence of multi disciplinary working taking place regularly. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure medication needs are met. EVIDENCE: There is no change in that all of the service users are dependent on staff to meet their care needs. Specific, detailed mobility care plans were in place to direct staff. A key worker system operates in the home; all four tenants have two key workers, which means that staff can ensure consistency and continuity of support to service users. Individual needs with regard to specialist equipment are clearly met and regularly reviewed. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 15 Specialist health professional support is provided through the CLDT. Individuals are registered with a local GP Practice. Comprehensive records in place evidenced that individuals’ physical and mental health needs are monitored on a regular basis. There were comprehensive policies and procedures in place regarding the administration and recording of medication. None of the current tenants are able to self-medicate. A requirement has been met through this inspection to include in both individuals care plans and medication profiles the individual practice of how medication is administered. Records held for the administration and disposal of medication were well maintained. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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) 22 & 23 The home has a satisfactory complaints system with evidence that tenants’ concerns are understood and acted upon. Arrangements are in place for protecting individuals from possible risk of harm or abuse. EVIDENCE: No complaints have been received by the home since the last inspection. It was evident through discussion with staff that although individuals are not able to communicate their views verbally, they can make themselves understood through physical gestures, body language and vocalisations. Several examples were given of when staff knew individuals were unhappy and their actions taken. The home has a formal policy and procedure on the Protection of Vulnerable Adults. The staff team have received training on the protection of vulnerable adults. A staff member spoken with was clear about the appropriate action to be taken if an incident of abuse was reported. There are procedures in place for staff to raise concerns. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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) 24 The organisation is failing to provide a safe and suitable environment to meet the needs of individuals. EVIDENCE: One of the ground floor bedrooms only offers 6.3 sq metres of usable floor space and is not suitable for the individual who occupies this room. This person has lived at the home for a number of years now and is settled, happy and well supported by the staff. The other ground floor bedroom is occupied by a wheelchair user and provides 9.8 sq metres of usable floor space. This bedroom is the only room with a wash hand basin, but the wash hand basin is not accessible to the service user in her wheelchair. Extending the property would be the ideal solution not only in relation to safety issues but also for their emotional and psychological welfare as it would prevent the need for them to move. The reconfiguration of the premises would also not only benefit both of the individuals but the others living at the home. Although the Commission has received plans for the reconfiguration of the home, discussion is still ongoing as to whether proposed plans are appropriate, and to ensure the best outcome for those individuals living at the home is considered fully. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 18 Therefore a requirement is unmet as to informing the Commission for Social Care Inspection when configuration work will commence. Again, as stated in previous inspections over the past few years, a rapid conclusion needs to be reached regarding the development of the property in order to provide a suitable environment to meet the assessed needs of two of the tenants. A requirement has been met for minor repairs to the bathroom. A requirement to tidy and maintain the garden is in the process of being implemented. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 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) 33 & 35 The home has an effective staff team supporting the needs of individuals. The training needs of staff are not being adequately met. EVIDENCE: The home has a stable staff team who are very familiar with the care needs of individuals living in the home. It was evident from interactions observed between staff and tenants that staff members work hard to develop positive relationships and offer innovative opportunities for personal development. Training records indicated that a requirement has been partially met for staff to be trained in manual handling. Some staff still require this training and also updates in first aid, food hygiene, and fire safety. Other areas of training that staff have attended are risk assessment, medication competency, health and safety and person-centred planning. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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) 42 The home needs to include all staff in all aspects of fire procedures in order to ensure the health and safety of both staff and the individuals living at the home. EVIDENCE: Records regarding the maintenance of fire equipment were up to date. Records indicated that not all staff had received fire instruction and also had not been included in recent fire drills. Other records observed that the home has made arrangements for water temperatures and electrical equipment to be tested. Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.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 x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x x Standard No 11 12 13 14 15 16 17 3 x 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Theobald House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 22 YES 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 1 Regulation 5 Timescale for action The manager to be provided with 30/11/05 an easy to understand document, which clearly sets out the fee charges that relate to the individual service users and how these fee charges are made up. Provide a safe and suitable 31/7/06 environment in order to meet the needs of 2 tenants. Update statutory training for 31/12/05 staff Ensure all staff receive fire instruction and attend fire drills on a regular basis 31/10/05 Requirement 2. 3. 4. 24 35 42 23(2) 18(1) 23(4) 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 Good Practice Recommendations Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Theobald House D56 D05 S8181 Theobald 238613 190805 Stage4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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