Inspection on 05/11/08 for Tikvah Tovah

This inspection was carried out on 5th November 2008.

CSCI found this care home to be providing an Good service.

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

Tikvah Tovah 08/11/06

Tikvah Tovah 28/12/05

Tikvah Tovah 01/06/05

Tikvah Tovah 13/12/04

Tikvah Tovah 05/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Tikvah Tovah Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Newman     Date: 0 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Tikvah Tovah Nine Mile Ride Ravenswood Village Crowthorne Berkshire RG45 6BQ 01344755529 Telephone number: Fax number: Email address: Provider web address: Tikvah@norwood.org.uk Name of registered provider(s): Name of registered manager (if applicable): Norwood Ravenswood Ltd T/A Norwood The registered provider is responsible for running the service Name of registered manager (if applicable) Miss Danielle Baird Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be acommodated is: 8 The registered person may provide the following category/ies of service only: Care home only (PC) to service uses of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Tikvah Tova is registered to provide support and care for five adults with learning disabilities. It is set in Ravenswood Village, which is a Jewish community. The village is situated near to Crowthorne; a controlled barrier protects the entrance drive. The Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 5 Brief description of the care home ethos of Tikvah Tova is derived from the Jewish faith; belief, practice and values of Judaism underpin all aspects of residents lives. The home is a bungalow and each resident has their own bedroom, none of them have en-suite facilities. There is a spacious lounge area and a separate dining room. The many facilities of the village are available to all Service users. Tikvah Tova has its own vehicle and Service users have access to public transport. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that was conducted over the course of 3 days and included a visit to the service of 4 hours duration. Time was spent observing practise in the service, talking to staff and the manager. A range of documentation was seen and a tour of the premises was undertaken. Information held about the service by the Commission and information provided by the home prior to the inspection was used in the formulation of this report. All outcome areas were good with two areas being judged as excellent. No requirements or recommendations were made as a result of this inspection. Care Homes for Adults (18-65 years) Page 6 of 26 The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, racial or cultural needs. No complaints have been received about this service by the Commission since the last inspection on 8.11.06. Fees range from 146,516 pounds to 63,753 pounds per annum and does not include the cost of toiletries or hairdressing. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with appropriate information, have their needs assessed and are introduced to the service according to their needs. Evidence: Discussion with the manager and documentation seen in respect of a service user who moved into the home since the last key inspection provided evidence that an appropriate assessment was made prior to a place being offered. An individual transition plan ensured that the needs of the service user were paramount throughout the process of him moving into the home. It was apparent that the imminent move of another service user into an adjacent building has been carefully planned with all involved parties. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users assessed and changing needs are appropriately reflected in their individual plan of care. Service users are encouraged and supported to make decisions about their lives and to take risks where appropriate. Evidence: All service users have their needs regularly assessed and a key worker system ensures that all paperwork in relation to service users is reviewed and updated regularly. Plans of care were seen in respect of 2 service users. They were detailed and followed a uniform format ensuring that all important information was easy to access. A diary for each service user has been introduced where they are supported to indicate and record their needs, wishes and choices. This information feeds into a quarterly report outlining how these aspirations have been fulfilled. Formal reviews involving relatives and other professionals are arranged at least annually. Using person centred planning, a process of providing care that is service Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: user focused, the service has started to conduct reviews in a manner that reflects the needs of the service user and supports their participation in the process. An example involved the use of photographs to demonstrate what activities a particular service user had engaged in over the previous year. Photographs were posted around the wall of the review meeting and enabled the service user to engage in the process for a substantial period of time. This was something that he had not been able to do previously. Another review involved the use of Widget a system of using symbols instead of words. This new practise is seen as excellent. It is the intention of the service to provide person centred reviews for all service users within the home as they arise. Work has been undertaken on implementing individual communication tools for service users. The manager is aware that further work is required but evidence suggests that greater understanding on the part of the staff team in relation to individual communication needs was reducing frustration experienced by some service users. The manager felt that the work undertaken to seek accreditation with the Autistic Society had also resulted in a deeper understanding of individual needs. The home has undertaken work to ascertain individual service users capacity to consent and evidence was available within plans of care. It was evident from discussion with staff members and from interactions observed with service users that decision-making is actively encouraged and supported. Guidance and assistance is provided to service users in relation to appropriate decisions such as choice of food, activities and bedtimes. A range of comprehensive risk assessments is in place that are individual to each service user and links to clear practise guidelines where appropriate. There was evidence that these are reviewed on a regular basis and adjusted according to changing needs. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users take part in valued occupational and leisure activities with their peer group and within the local community. They are supported with appropriate relationships and to maintain links with family and friends. Service users are enabled to choose from a healthy diet. Evidence: Service users are encouraged and supported to lead fulfilling lives appropriate to their needs, wishes and preferences. Each service user has a full programme of activities including a wide range of leisure pursuits, aromatherapy sessions, music, swimming, and art sessions, shopping and restaurant trips and day centre attendance. Activities are also conducted within the home and form part of the plans for individuals. Community access is actively supported and encouraged and evidence seen within activity plans and care plans confirmed that service users access the doctors, dentist, Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: restaurants and cafes. An activity board is displayed in the communal area and details the wishes and events attended by service users. Service users meetings are held weekly and now involve the use of photographs to aid participation and this was reported to have been very successful. All service users have a holiday according to their individual needs and preferences. This may take the form of day trips if this is more suited to the needs of the individual. The home has a dedicated vehicle but does use other forms of transport on occasions. Evaluations are made following each trip to ensure that they are appropriate for individual service users and to provide evidence of the activity and the service users positive participation. Each service user file contains details of family, friends and advocates. The home actively encourages contact with family and supports two service users to visit their family home on a fortnightly basis. It was clear from discussion with staff members that the philosophy of the home promotes the rights of the service users and recognises their responsibilities. Care plans seen contain information about daily tasks and routines for individual service users. The arrangements for the provision of food is overseen by one designated member of staff. The menu planner was seen and it provided evidence that a wide range of healthy foods are provided in the home based upon individual choice, preference and needs. Observation conducted during the course of the lunch confirmed that staff encourage and support service users to make choices using their preferred communication methods. The home received a positive food safety inspection by the local Environmental Health Dept in November 2007. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support in the way they prefer and their physical and emotional health care needs are well met. Service users are protected by the homes policies and procedures on dealing with medicines. Evidence: The plans of care seen provided comprehensive information about the personal and health care needs of individual service users. Preferences in relation to personal care was clearly recorded and enabled staff to ensure that they undertook tasks with individual service users that focused upon their needs and reduced anxiety and frustration. The manager and the staff spoken to had sound and detailed knowledge of individual needs and preferences. Daily routines are flexible and bedtimes and mealtimes are not rigidly enforced but take account of individual timetables. All service users have a range of health checks undertaken on a regular basis. Their general health and well being is closely monitored by staff. It was evident from plans of care that a wide range of health care professionals are called upon according to individual service users needs. For example Physiotherapy, Speech Therapy, Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Chiropody, Dentist, General Practitioners, Psychiatrist and various hospital departments have been utilised and were evident within plans of care seen. All appointments and outcomes are recorded. There are no service users who currently administer their own medication. The home has recently changed its medication provider and positive outcomes from this change were reported by the manager. All staff who administer medication have received appropriate training with regular refresher training being provided. The medication prescribed for individual service users is reviewed regularly as needs change and at least on an annual basis. A Pharmacist from the Primary Care Trust reviewed the medication procedures within the home on 15.2.08 and considered that all the standards were met. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have their views listened to and are protected from abuse, neglect and self-harm. Evidence: There is a robust and comprehensive complaints procedure in place that is provided by the Organisation. The complaints record indicated that no complaints had been received by the service since the last inspection. Throughout the course of the inspection it was evident that the wishes and views of service users is seen as paramount in providing an individual service to them. All staff have received training in safeguarding adults. An example was provided where a service user had had an accident that gave rise to concerns about the staff on duty at the time. Although no definitive outcome was achieved a full, open and transparent investigation was undertaken. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a homely, safe and very comfortable environment that is maintained in a clean and hygienic condition. Evidence: A tour of the premises was undertaken. The home is appropriately decorated and is comfortably furnished. Some individual bedrooms were seen and had clearly been decorated, furnished and personalised according the needs and preferences of the individual occupant. The communal areas were spacious and had been arranged to meet the needs of current service users by accomodating mobility aids etc. There is a garden for the use of service users that is well used during warmer weather. It was noted that a completely new kitchen had been installed since the last inspection. There is a good range of assisted bathing facilities and one bathroom has sensory equipment installed, which has improved the experience for some service users and created a much calmer atmosphere for the task. Maintenance issues are raised when identified and acted upon without delay. Repairs to the heating system were being carried out during the course of the inspection. The home has a designated laundry room and throughout the home was clean, tidy Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: and fresh smelling. A staff cleaning schedule was in evidence and ensures that the standards of cleanliness in the home are maintained. COSHH data sheets are kept for all cleaning materials used in the home. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by competent, well-trained and qualified staff and are protected by the homes recruitment policies and practises. Evidence: The Organisation provides a comprehensive staff training programme that includes National Vocational Qualification training, specialist learning disability awards and ongoing core training including moving and handling, food hygienes, fire awareness and safeguarding adults. All new staff are required to undergo induction training to Skills4care standards and guidelines. In was confirmed in discussion with staff that induction is provided and expected of all new staff. Once induction has been completed staff move to more advanced training such as NVQ. The training department is well organised and notifies services when updates or refresher training is due for individual staff. Each staff member has a training profile where copies of training certificates are maintained. The training department keeps a training profile for the home as a whole. Positive interactions between service users and staff were observed throughout the course of the inspection. Service users were supported appropriately and clearly benefited from a good rapport with staff members. Overall staff appeared confident in their roles and those spoken to indicated that they were well supported by the Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: management within the home and by fellow team members. A shift planner is posted in the hallway and includes photographs of staff on duty enabling service users to see who is working in the home. Staff meetings are held weekly and staff spoken felt that they were useful. Communication between staff was considered good with a range of tools being used to support this including a staff communication book, a shift planner, a 24 hour report book and regular shift handovers. The organisation has a robust recruitment system that is administered centrally. Evidence was accepted from information provided by the service and from knowledge of the organisation that no staff member commences employment within the home without having provided all the necessary documentation as dictated by the regulations. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in a manner that reflects the views of service users. The health, safety and welfare of service users are promoted and protected. Evidence: The current manager is highly experienced and well qualified. She was described by those staff spoken to as very professional, competent and approachable. It was apparent from discussions with the manager that she is constantly looking to improve the service and to develop her own learning. The service is monitored in various ways including the use of Regulation 26 visits, Lay monitoring visits and standardisation visits that are undertaken by managers from other homes within the organisation. A questionnaire is distributed to service users and their families on an annual basis and it is the intention of the manager to include other stakeholders such as Care Managers and other health care professionals. Feedback from service users is obtained from observations of their reactions to activities and verbal comments from those service users who have speech and Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: understanding. There is an annual development plan for the service. A wide for fire checks overall range of health and safety checks are undertaken. Including the arrangements safety, portable appliance tests, regular servicing of equipment, gas safety and water blending valve checks. Accidents and incidents are recorded and these were low in number. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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